Kim Hee Seung, Park Noh Hyun, Wu Hong Gyun, Cho Jeong Yeon, Chung Hyun Hoon, Kim Jae Weon, Song Yong Sang, Kim Seung Hyup, Kang Soon Beom
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yungun-Dong, Chongno-Gu, Seoul, 110-744, Republic of Korea.
Ann Surg Oncol. 2009 Jan;16(1):133-9. doi: 10.1245/s10434-008-0197-3. Epub 2008 Nov 1.
We sought to compare the efficacy and toxicity between surgery followed by concurrent chemoradiation and primary concurrent chemoradiation in patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ib1-IIa squamous cell carcinoma of cervix and suspicious para-aortic lymph node metastasis by preoperative computed tomographic and magnetic resonance imaging. From January 2000 to December 2007, 48 patients treated with radical hysterectomy with pelvic and para-aortic lymphadenectomy followed by concurrent chemoradiation (group 1) were matched to 16 patients treated with primary concurrent chemoradiation (group 2) from medical records. Primary end points were progression-free survival (PFS) and overall survival, and secondary end points were late complications by concurrent chemoradiation and pattern of disease recurrence. Among 48 patients in group 1, 39 (81.3%) and 35 (72.9%) had histologic pelvic and para-aortic lymph node metastases, respectively. Distant metastasis was more frequent in group 2 than in group 1 (37.6% vs. 12.5%, p = 0.027), although there was no difference in locoregional recurrence between the two groups. Surgery followed by concurrent chemoradiation and FIGO stage Ib1 were only statistically significant factors for improved PFS (adjusted hazard ratio, 0.231 and 0.244; 95% confidence interval, 0.072-0.821 and 0.086-0.697), although there was no prognostic factor for overall survival. Furthermore, there was no difference in grade 3 or 4 late complications between groups 1 and 2 (25.0% vs. 31.3%, p = 0.745). Surgery followed by concurrent chemoradiation may improve PFS and reduce distant metastasis without difference in late complications compared with primary concurrent chemoradiation in patients with FIGO stage Ib1-IIa squamous cell carcinoma of cervix and suspicious para-aortic lymph node metastasis.
我们试图比较在国际妇产科联盟（FIGO）Ib1-IIa期宫颈鳞状细胞癌且术前计算机断层扫描和磁共振成像提示可疑主动脉旁淋巴结转移的患者中，手术联合同步放化疗与单纯同步放化疗的疗效和毒性。2000年1月至2007年12月，从病历中选取48例行根治性子宫切除术加盆腔及主动脉旁淋巴结清扫术并联合同步放化疗的患者（第1组），与16例行单纯同步放化疗的患者（第2组）进行匹配。主要终点为无进展生存期（PFS）和总生存期，次要终点为同步放化疗引起的晚期并发症及疾病复发模式。第1组的48例患者中，分别有39例（81.3%）和35例（72.9%）有组织学证实的盆腔和主动脉旁淋巴结转移。第2组远处转移比第1组更常见（37.6%对12.5%，p = 0.027），尽管两组局部区域复发无差异。手术联合同步放化疗和FIGO Ib1期是仅有的对改善PFS有统计学意义的因素（校正风险比分别为0.231和0.244；95%置信区间为0.072 - 0.821和0.086 - 0.697），尽管没有总生存期的预后因素。此外，第1组和第2组3级或4级晚期并发症无差异（25.0%对31.3%，p = 0.745）。对于FIGO Ib1-IIa期宫颈鳞状细胞癌且可疑主动脉旁淋巴结转移的患者，手术联合同步放化疗与单纯同步放化疗相比，可能改善PFS并减少远处转移，且晚期并发症无差异。
