Ferrandina Gabriella, Macchia Gabriella, Legge Francesco, Deodato Francesco, Forni Franca, Digesù Cinzia, Carone Vito, Morganti Alessio G, Scambia Giovanni
Gynecologic Oncology Unit, Catholic University of Rome, Rome, Italy.
Oncology. 2008;74(1-2):42-9. doi: 10.1159/000138979. Epub 2008 Jun 10.
We investigated the role of squamous cell carcinoma (SCC) at presentation (pre-SCC) and after treatment (post-SCC) as predictor of pathological response and outcome in locally advanced cervical cancer (LACC) patients undergoing preoperative chemoradiation.
One hundred and twenty-three consecutive LACC patients underwent preoperative chemoradiation including cisplatin and 5-fluorouracil plus external radiotherapy to the whole pelvic region. Clinical responders underwent radical surgery. SCC levels were expressed in nanograms/milliliter.
Ninety-five of 123 (77.2%) and 15/113 (13.3%) cases were classified as having high pre-SCC and high post-SCC levels. Complete pathological response was documented in 51 cases (41.5%), while persistence of microscopic foci was shown in 40 cases (32.5%). In the univariate analysis, FIGO (International Federation of Gynecology and Obstetrics) stage, clinical response to treatment and post-SCC levels were associated with pathological response to chemoradiation. In the multivariate analysis, only clinical response to treatment and post-SCC levels retained an independent role as predictors of pathological response to treatment. Cases with high post-SCC status had a shorter disease-free survival than cases with low post-SCC levels (p = 0.028). In the multivariate analysis, lack of a pathological complete response/persistence of microscopic foci to treatment retained an independent negative prognostic role for disease-free survival.
Post-SCC identifies LACC patients with a poor chance of pathological response to chemoradiation and an unfavorable outcome.
我们研究了在接受术前放化疗的局部晚期宫颈癌（LACC）患者中，鳞状细胞癌（SCC）在治疗前（pre-SCC）和治疗后（post-SCC）作为病理反应和预后预测指标的作用。
123例连续的LACC患者接受了术前放化疗，包括顺铂和5-氟尿嘧啶加全盆腔外照射放疗。临床缓解者接受根治性手术。SCC水平以纳克/毫升表示。
123例中的95例（77.2%）和113例中的15例（13.3%）被分类为pre-SCC水平高和post-SCC水平高。51例（41.5%）记录有完全病理缓解，而40例（32.5%）显示有微小病灶残留。在单因素分析中，国际妇产科联盟（FIGO）分期、对治疗的临床反应和post-SCC水平与放化疗的病理反应相关。在多因素分析中，只有对治疗的临床反应和post-SCC水平作为治疗病理反应的预测指标保留独立作用。post-SCC状态高的病例无病生存期比post-SCC水平低的病例短（p = 0.028）。在多因素分析中，治疗后缺乏病理完全缓解/微小病灶残留对无病生存期保留独立的负性预后作用。
post-SCC可识别出对放化疗病理反应机会低且预后不良的LACC患者。
