Legge F, Chiantera V, Macchia G, Fagotti A, Fanfani F, Ercoli A, Gallotta V, Morganti A G, Valentini V, Scambia G, Ferrandina G
Gynecologic Oncology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy.
Gynecologic Oncology Unit, "Giovanni Paolo II" Foundation, Campobasso, Italy.
Gynecol Oncol. 2015 Jul;138(1):83-8. doi: 10.1016/j.ygyno.2015.04.035. Epub 2015 May 1.
Recurrence of disease represents a clinical challenge in cervical cancer patients, especially when all available treatment modalities have been used in the primary setting. The aim of this study was to analyze the patterns of recurrence and their association with clinical outcome in locally advanced cervical cancer (LACC) patients submitted to primary chemoradiation (CTRT) followed by radical surgery (RS).
This study was conducted on 364 LACC patients treated with CTRT plus RS since January 1996 to July 2012. For each relapse, information on date of clinical/pathological recurrence, and pattern of disease presentation were retrieved. Post-relapse survival (PRS) was recorded from the date of recurrence to the date of death for disease or last seen. Survival probabilities were compared by the log rank test. Cox's regression model with stepwise variable selection was used for multivariate prognostic analysis for PRS.
Within a median follow-up of 42months, 75 recurrences (20.6%) and 54 disease-associated deaths (14.8%) were recorded. By analysing the pattern of relapse, most of the recurrences were outside the irradiated field (n=43, 57.3%) and the most frequently observed site was visceral (n=16, 21.3%). Among the parameters of the recurrence associated with PRS including the pattern of recurrence, the size of recurrence, SCC-Ag serum levels at recurrence, and secondary radical surgery, only the last one retained an independent predictive role in reducing the risk of death (p=0.037).
The feasibility of secondary radical resection positively impacts on PRS of LACC patients submitted to multimodality primary treatments.
疾病复发是宫颈癌患者面临的一项临床挑战，尤其是在原发治疗中已采用了所有可用治疗方式的情况下。本研究的目的是分析局部晚期宫颈癌（LACC）患者在接受原发放化疗（CTRT）后行根治性手术（RS）的复发模式及其与临床结局的关联。
本研究对1996年1月至2012年7月期间接受CTRT加RS治疗的364例LACC患者进行。对于每次复发，获取临床/病理复发日期及疾病表现模式的信息。记录复发后生存（PRS）时间，从复发日期至因疾病死亡或最后一次随访的日期。采用对数秩检验比较生存概率。使用逐步变量选择的Cox回归模型对PRS进行多因素预后分析。
在中位随访42个月期间，记录到75例复发（20.6%）和54例疾病相关死亡（14.8%）。通过分析复发模式，大多数复发发生在放疗野之外（n = 43，57.3%），最常观察到的部位是内脏（n = 16，21.3%）。在与PRS相关的复发参数中，包括复发模式、复发大小、复发时鳞状细胞癌抗原（SCC-Ag）血清水平及二次根治性手术，只有最后一项在降低死亡风险方面保留独立预测作用（p = 0.037）。
二次根治性切除的可行性对接受多模式原发治疗的LACC患者的PRS有积极影响。
