Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria; Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, Netherlands.
Gynecol Oncol. 2014 May;133(2):256-62. doi: 10.1016/j.ygyno.2014.02.004. Epub 2014 Feb 8.
The aim of this study is to investigate patterns of distant relapse after primary radiochemotherapy in cervical cancer patients.
All patients with cervical cancer treated in curative intent with external beam radiotherapy +/- chemotherapy and image-guided adaptive brachytherapy between January 1998 and June 2009 at the Medical University of Vienna were included in this retrospective analysis. Patients with locoregional recurrences were excluded from this study. Presence, site of and time to distant metastases were recorded. For identifying prognostic factors, uni- and multivariate analyses using Cox regression analysis were performed. Based on the result from the multivariate analysis, patients were stratified into a high and a low risk group. The Kaplan-Meier method was used to estimate distant-metastasis-free-survival in the overall cohort, in the risk groups and for analysing the impact of chemotherapy within the risk groups.
A total number of 189 patients were included in this study. After a median follow-up of 54 months, 49 patients developed distant metastases. Overall, distant-metastasis-free-survival 5 years after treatment was 73%. FIGO stage, lymph node status and the extent of tumour regression during treatment were significant predictors for distant metastasis. Distant-metastasis-free-survival 5 years after treatment was 91% and 60% in the low and high risk groups, respectively. The number of the cycles of chemotherapy had a significant impact on the occurrence of distant metastasis in high risk patients, but not in low risk patients.
Patients with high risk factors have a 40% probability of developing distant metastasis within 5 years. In these patients, decreasing the number of cycles of cisplatin may increase their probability of developing distant metastasis.
本研究旨在探讨宫颈癌患者接受放化疗后远处复发的模式。
本回顾性分析纳入了 1998 年 1 月至 2009 年 6 月期间在维也纳医科大学接受根治性外照射放疗±化疗和图像引导自适应近距离放疗的所有宫颈癌患者。本研究排除了局部区域复发的患者。记录远处转移的存在、部位和时间。为了确定预后因素，采用 Cox 回归分析进行了单因素和多因素分析。基于多因素分析的结果，将患者分为高风险和低风险组。采用 Kaplan-Meier 法估计总队列、风险组的远处无转移生存情况，并分析风险组内化疗的影响。
本研究共纳入 189 例患者。中位随访 54 个月后，49 例患者发生远处转移。总体而言，治疗后 5 年远处无转移生存率为 73%。FIGO 分期、淋巴结状态和治疗期间肿瘤消退程度是远处转移的显著预测因素。治疗后 5 年低风险组和高风险组的远处无转移生存率分别为 91%和 60%。高危患者中化疗周期数对远处转移的发生有显著影响，但在低危患者中无显著影响。
高危因素患者在 5 年内发生远处转移的概率为 40%。在这些患者中，减少顺铂的化疗周期数可能会增加远处转移的概率。
