根治性盆腔脏器切除术治疗原发性或复发性宫颈癌的生存情况：167 例患者的回顾性多中心研究。

Survival after curative pelvic exenteration for primary or recurrent cervical cancer: a retrospective multicentric study of 167 patients.

机构信息

*Department of Gynecology and Gynecological Oncology, Campus Mitte (CCM) and Campus Benjamin Franklin (CBF), Charitè University Berlin, Berlin, Germany; †Gynecologic Oncology Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy; ‡Department of Radiooncology, Campus Mitte (CCM) and Campus Virchow (CVK), Charitè University Berlin, Berlin, Germany; §Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy; ∥Università di Milano, Fondazione Policlinico Milano, Milan, Italy; and ¶Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Campobasso, Italy.

出版信息

Int J Gynecol Cancer. 2014 Jun;24(5):916-22. doi: 10.1097/IGC.0b013e3182a80aec.

DOI:10.1097/IGC.0b013e3182a80aec

PMID:24442006

Abstract

OBJECTIVE

Evaluate the survival of patients who underwent pelvic exenteration (PE) with curative intent for primary persistent or recurrent cervical cancer.

METHODS

We retrospectively investigated 167 consecutive patients, referred to the gynecological oncology units of 4 centers in Germany or Italy, who underwent PE. Data regarding surgery, histology, and oncologic outcomes were collected and statistically evaluated. Survival was determined from the day of exenteration until last follow-up or death.

RESULTS

The median age was 51 years. Twenty-seven patients (16.2%) underwent PE owing to advanced primary tumors (group A), 34 patients (20.4%) underwent PE owing to persistent cancer after chemotherapy or chemoradiation (group B), and 106 patients (63.4%) underwent PE owing to recurrence (group C). The prevalent histologic type was squamous cell cancer. A complete tumor resection (R0), was achieved in 121 patients (72.5%). Forty-nine patients (29.3%) had pelvic lymph node metastases and 44 patients (26.3%) had pelvic sidewall involvement. Overall survival at the end of the study was 40.7%. The cumulative 5-year overall survival for the entire cohort was 38%. Resection margins, pelvic lymph node state, and sidewall involvement were independent prognostic factors in multivariate analysis.

CONCLUSION

Pelvic exenteration is a valid therapeutic option for patients with locally advanced primary persistent or recurrent cervical cancer, with a long-term survival in 40% of the patients.

摘要

目的

评估行根治性盆腔切除术（PE）治疗原发性持续性或复发性宫颈癌患者的生存情况。

方法

我们回顾性调查了 167 例连续患者，这些患者被转诊至德国或意大利的 4 个中心的妇科肿瘤学部门，接受了 PE。收集了有关手术、组织学和肿瘤学结果的数据，并进行了统计学评估。生存时间从切除术当天计算至最后一次随访或死亡。

结果

中位年龄为 51 岁。27 例患者（16.2%）因晚期原发性肿瘤而行 PE（A 组），34 例患者（20.4%）因化疗或放化疗后持续性癌症而行 PE（B 组），106 例患者（63.4%）因复发而行 PE（C 组）。主要组织学类型为鳞状细胞癌。121 例患者（72.5%）实现了完全肿瘤切除（R0）。49 例患者（29.3%）有盆腔淋巴结转移，44 例患者（26.3%）有骨盆侧壁受累。研究结束时的总生存率为 40.7%。整个队列的 5 年总生存率累积为 38%。多变量分析显示，切缘、盆腔淋巴结状态和侧壁受累是独立的预后因素。