Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
Int J Gynecol Cancer. 2012 May;22(4):623-9. doi: 10.1097/IGC.0b013e3182473277.
The aim of this study was to identify predictors of the response to paclitaxel-carboplatin chemotherapy (TC) in recurrent or patients with advanced cervical cancer.
The records of 61 consecutive women with recurrent or advanced cervical cancer who were treated with TC were retrospectively reviewed. Data regarding their primary disease, follow-up, recurrence, and the activity and toxicity of TC were collected. Multivariate analysis was performed using the Cox proportional hazards regression model to identify predictors of the response to TC. Survival was calculated using the Kaplan-Meier method and compared using the log-rank test.
Overall, TC was well tolerated and displayed a response rate of 60.7% (19 complete response and 18 partial response). The median progression-free survival was 14 months for all patients and 20 months for the responders. Grade 3 to grade 4 toxicities were observed in 51 patients (83.6%). Multivariate analysis revealed that performance status, symptom status, and prior chemotherapy were independent prognostic predictors of a poor response. Patient survival was inversely correlated with the number of these prognostic factors. When the patients were divided into 2 prognostic groups (low risk: patients with no or one poor prognostic factor; and high-risk: patients with 2 or more poor prognostic factors), the patients in the high-risk group had a significantly shorter progression-free survival than those in the low-risk group (4 vs 16 months, log-rank; P < 0.0001).
The combination of paclitaxel and carboplatin is effective in patients with recurrent or advanced cervical cancer. Our prognostic model composed of 3 clinical variables might enable physicians to identify patients who would not derive clinical benefit from TC and offer them the opportunity to receive other types of treatment.
本研究旨在确定紫杉醇联合卡铂化疗（TC）治疗复发性或晚期宫颈癌患者反应的预测因素。
回顾性分析 61 例接受 TC 治疗的复发性或晚期宫颈癌连续女性患者的记录。收集了有关其主要疾病、随访、复发以及 TC 的活性和毒性的数据。使用 Cox 比例风险回归模型进行多变量分析，以确定 TC 反应的预测因素。使用 Kaplan-Meier 方法计算生存，并使用对数秩检验进行比较。
TC 总体耐受良好，反应率为 60.7%（19 例完全缓解，18 例部分缓解）。所有患者的中位无进展生存期为 14 个月，缓解者为 20 个月。51 例患者（83.6%）出现 3 级至 4 级毒性。多变量分析显示，体能状态、症状状态和既往化疗是反应不良的独立预后预测因素。患者生存与这些预后因素的数量呈反比。当患者被分为 2 个预后组（低危：无或仅有 1 个不良预后因素的患者；高危：有 2 个或更多不良预后因素的患者）时，高危组患者的无进展生存期明显短于低危组（4 个月比 16 个月，对数秩；P < 0.0001）。
紫杉醇联合卡铂在复发性或晚期宫颈癌患者中有效。我们由 3 个临床变量组成的预后模型可以帮助医生识别不会从 TC 中获得临床获益的患者，并为他们提供接受其他类型治疗的机会。
