Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH 44195, USA.
Gynecol Oncol. 2010 May;117(2):270-5. doi: 10.1016/j.ygyno.2010.01.045. Epub 2010 Feb 24.
To estimate the significance of hydronephrosis and impact of ureteral obstruction relief on outcome in patients with stage IIIB cervical cancer treated with radiation and concurrent chemotherapy.
We retrospectively studied stage IIIB cervical cancer patients treated on GOG trials 56, 85, 120 and 165 evaluating radiation and concurrent chemotherapy. Eligible patient records were reviewed to assess the presence of hydronephrosis and treatment of ureteral obstruction. Patients were classified into three groups; no hydronephrosis, hydronephrosis relieved from ureteral obstruction via stent or percutaneous nephrostomy and hydronephrosis without treatment of ureteral obstruction.
539 stage IIIB patients were studied. Hydronephrosis was present in 238 (44.2%). Patient age, race, and tumor characteristics (size, histology and grade) were not significantly different between patients with or without hydronephrosis. Patients with hydronephrosis received similar doses of radiation and cisplatin-based chemotherapy. Both overall and progression-free survival were worse with hydronephrosis (log-rank test p value=0.0189 and 0.0186, respectively). Univariable analysis identified five prognostic factors; pelvic nodal metastasis (p=0.0001), tumor diameter (p=0.0007), cisplatin-based concurrent chemoradiation (p=0.0031), hydronephrosis (p=0.0189), and performance status (p=0.0359). Hydronephrosis was associated with worse performance status (p<0.001). On multivariable analysis hydronephrosis was not a significant prognostic factor. Ureteral obstruction relief occurred for 88% of patients and was associated with improved survival.
In patients with stage IIIB cervical cancer restricted to the pelvis, hydronephrosis at presentation is a significant but not independent prognostic factor associated with poor performance status and poorer survival. Relief of ureteral obstruction is correlated with improved outcome.
评估 IIIB 期宫颈癌患者出现肾积水及解除输尿管梗阻对接受放疗联合化疗患者结局的影响。
我们对接受 GOG 试验 56、85、120 和 165 研究的 IIIB 期宫颈癌患者进行了回顾性研究，评估了放疗联合化疗的效果。对符合条件的患者病历进行了评估，以确定是否存在肾积水及是否对输尿管梗阻进行了治疗。患者被分为三组：无肾积水、肾积水经支架或经皮肾造瘘术解除输尿管梗阻和未治疗肾积水。
共研究了 539 例 IIIB 期患者。238 例（44.2%）患者存在肾积水。肾积水患者与无肾积水患者的年龄、种族和肿瘤特征（大小、组织学和分级）无显著差异。肾积水患者接受了相似剂量的放疗和以顺铂为基础的化疗。肾积水患者的总生存率和无进展生存率均较差（log-rank 检验 P 值分别为 0.0189 和 0.0186）。单变量分析确定了 5 个预后因素：盆腔淋巴结转移（p=0.0001）、肿瘤直径（p=0.0007）、以顺铂为基础的同期放化疗（p=0.0031）、肾积水（p=0.0189）和体能状态（p=0.0359）。肾积水与较差的体能状态相关（p<0.001）。多变量分析显示，肾积水不是一个显著的预后因素。88%的患者解除了输尿管梗阻，且生存得到改善。
在局限于盆腔的 IIIB 期宫颈癌患者中，出现肾积水是一个显著但非独立的预后因素，与较差的体能状态和较差的生存相关。解除输尿管梗阻与改善结局相关。
