Jain P, Hunter R D, Livsey J E, Coyle C, Kitchener H C, Swindell R, Davidson S E
Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom.
Int J Gynecol Cancer. 2006 Sep-Oct;16(5):1839-45. doi: 10.1111/j.1525-1438.2006.00703.x.
The objective of this study was to assess treatment outcomes in a large case series of cervical cancer patients undergoing postoperative radiotherapy in a single center. Case notes of women referred to the Christie Hospital during 1985-1997 for postoperative adjuvant radiotherapy for cervical cancer were reviewed. Of 478 women eligible for analysis, 282 (58.9%) underwent radical hysterectomy and 196 (41.1%) had nonradical hysterectomy. The disease-specific 5-year survival for the study population is 70.1%, with a 5-year risk of developing any recurrence of 30.5% and a 5-year grade 3 morbidity rate of 3.9%. Survival was significantly higher, ie, 80.9% vs 62.7% (P = 0.0001) and recurrence was significantly lower, ie, 18.6% vs 38.8% (P < 0.00005) in the group of women who had adjuvant radiotherapy following a nonradical hysterectomy compared with radical surgery. Thirty percent of women having "radical" surgery had positive resection margins and required postoperative adjuvant pelvic radiotherapy. Women with node-positive disease, who received adjuvant radiotherapy, had a high rate of distant metastases. These women would receive chemoradiotherapy now as primary treatment because of the risk of developing distant metastases. If, despite staging investigations, surgery reveals node-positive disease, then these women should receive adjuvant chemoradiotherapy. Survival was better in women who had nonradical surgery due to smaller volume disease when cancers were unsuspected and hence will have been cured by surgery alone. Multidisciplinary team working, as recommended by national guidelines from 1999, should allow better patient selection for treatment.
本研究的目的是评估在单一中心接受术后放疗的大量宫颈癌患者的治疗结果。回顾了1985年至1997年间转诊至克里斯蒂医院接受宫颈癌术后辅助放疗的女性患者的病历。在478名符合分析条件的女性中，282名（58.9%）接受了根治性子宫切除术，196名（41.1%）接受了非根治性子宫切除术。该研究人群的疾病特异性5年生存率为70.1%，5年发生任何复发的风险为30.5%，5年3级发病率为3.9%。与根治性手术相比，非根治性子宫切除术后接受辅助放疗的女性组生存率显著更高，即80.9%对62.7%（P = 0.0001），复发率显著更低，即18.6%对38.8%（P < 0.00005）。接受“根治性”手术的女性中有30%切缘阳性，需要术后辅助盆腔放疗。接受辅助放疗的淋巴结阳性疾病女性远处转移率较高。由于存在发生远处转移的风险，这些女性现在将接受放化疗作为主要治疗。如果尽管进行了分期检查，但手术显示淋巴结阳性疾病，那么这些女性应接受辅助放化疗。因疾病体积较小而接受非根治性手术的女性生存率更好，因为癌症未被怀疑，因此仅手术就可治愈。按照1999年国家指南的建议进行多学科团队协作，应能更好地选择患者进行治疗。
