局部晚期腺癌/腺鳞癌与宫颈鳞癌根治性放疗的临床特征、疗效及预后差异。
Differential clinical characteristics, treatment response and prognosis of locally advanced adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma of cervix treated with definitive radiotherapy.
机构信息
Department of Oncology, National Taiwan University Hospital Yun Lin Branch, Yun-Lin, Taiwan.
出版信息
Acta Obstet Gynecol Scand. 2014 Jul;93(7):661-8. doi: 10.1111/aogs.12383. Epub 2014 Apr 22.
OBJECTIVE
To compare tumor characteristics and clinical outcome of patients with cervical locally advanced adenocarcinoma (AC)/adenosquamous carcinoma (ASC) and squamous cell carcinoma (SCC).
DESIGN
Retrospective study.
SETTING
National Taiwan University Hospital, Taipei, Taiwan.
POPULATION
All patients with cervical SCC (n = 35), AC or ASC (n = 194) with FIGO stage ≥IIB who received definitive radiotherapy or concurrent chemoradiotherapy (CCRT) from January 1995 to December 2009.
METHOD
Medical and histopathological record review.
MAIN OUTCOME MEASURES
Progression-free survival (PFS), local recurrence-free survival, distant metastasis-free survival, and overall survival (OS).
RESULTS
Compared with the SCC subgroup, patients with AC/ASC were significantly younger (p = 0.007), more of them without clinical symptoms were diagnosed by abnormal Pap smear findings (p = 0.043), and less responded to treatment (p = 0.018). After a median follow-up of 59.3 months, patients with AC/ASC had worse 5-year PFS (30.0% vs. 47.6%, p = 0.044), worse 5-year distant metastasis-free survival (41.5% vs. 69.9%, p = 0.005), and trends toward worse 5-year local recurrence-free survival (64.4% vs. 76.2%, p = 0.165) and worse 5-year OS (41.3% vs. 58.1%, p = 0.090) than patients with SCC. In univariate analysis, early FIGO stage and complete treatment response were significantly associated with PFS and OS. Histology of non-AC/ASC and Point A biologically equivalent doses in 2-Gy fractions >85 Gy were significantly associated with better PFS, and CCRT was significantly associated with better OS. In multivariate analysis, complete treatment response and early FIGO stage remained significant factors for predicting better PFS and OS.
CONCLUSIONS
Cervical AC/ASC may be more aggressive than is SCC. For cervical AC/ASC, more comprehensively effective treatments are warranted.
目的
比较宫颈局部晚期腺癌（AC）/腺鳞癌（ASC）和鳞癌（SCC）患者的肿瘤特征和临床结局。
设计
回顾性研究。
地点
中国台湾台北市，台湾大学医院。
人群
所有接受根治性放疗或同期放化疗（CCRT）的宫颈 SCC（n=35）、FIGO 分期≥IIB 的 AC 或 ASC 患者（n=194），患者均于 1995 年 1 月至 2009 年 12 月入组。
方法
回顾性分析医疗和组织病理学记录。
主要观察指标
无进展生存期（PFS）、局部无复发生存期、远处无转移生存期和总生存期（OS）。
结果
与 SCC 亚组相比，AC/ASC 患者明显更年轻（p=0.007），更多患者无症状，通过巴氏涂片异常发现诊断（p=0.043），治疗反应较差（p=0.018）。中位随访 59.3 个月后，AC/ASC 患者 5 年 PFS 更差（30.0% vs. 47.6%，p=0.044），5 年远处无转移生存率更差（41.5% vs. 69.9%，p=0.005），5 年局部无复发生存率也有下降趋势（64.4% vs. 76.2%，p=0.165），5 年 OS 更差（41.3% vs. 58.1%，p=0.090）。单因素分析显示，早期 FIGO 分期和完全治疗反应与 PFS 和 OS 显著相关。非 AC/ASC 组织学和 2-Gy 分数中 Point A 生物等效剂量>85 Gy 与更好的 PFS 显著相关，CCRT 与更好的 OS 显著相关。多因素分析显示，完全治疗反应和早期 FIGO 分期仍然是预测更好 PFS 和 OS 的重要因素。
结论
宫颈 AC/ASC 可能比 SCC 更具侵袭性。对于宫颈 AC/ASC，需要更全面有效的治疗。
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