Li Xin, Wei Li-Chun, Zhang Ying, Zhao Li-Na, Li Wei-Wei, Ping Li-Jian, Dang Yun-Zhi, Hu Jing, Shi Mei
Department of Radiation Oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China.
Int J Gynecol Cancer. 2016 Oct;26(8):1472-9. doi: 10.1097/IGC.0000000000000778.
The purpose of this study is to determine the prognostic significance of pelvic lymph node (PLN) characteristics and perform risk stratification in patients undergoing concurrent chemoradiotherapy for locally advanced cervical squamous cell carcinoma.
We retrospectively reviewed the records of 609 patients with Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stage II to IVa who underwent concurrent chemoradiotherapy, compared overall survival (OS), distant metastasis-free survival (DMFS), and pelvic recurrence-free survival between patients with or without PLN involvement. We further analyzed prognostic factors for OS and DMFS including FIGO stage, tumor volume, and lymph node (LN) characteristics in 300 patients with PLN involvement.
The 3-year OS rate was 81.7% versus 92.8% (P = 0.002) and the 3-year DMFS rate was 79.3% versus 92.7% (P = 0.006) in patients with or without PLN involvement, respectively. With univariable analysis, FIGO stage, LN-volume, LN-number, LN-diameter, and matted/necrotic LN affected both OS and DMFS. Based on multivariable analysis, we created a risk stratification model. For OS, the independent risk factors were FIGO stage III or IVa, LN-volume of 3 cm or more, LN-diameter of 1.5 cm or more, and matted/necrotic LN. The low-risk group (no risk factors), mid-risk group (1 or 2 risk factors), and high-risk group (3 or 4 risk factors) had a 3-year OS of 96.6%, 84.9%, and 64.7%, respectively (P = 0.005). For DMFS, LN-diameter of 1.5 cm or more, LN-number of 3 or more, and matted/necrotic LN were the independent risk factors. The subgroups for DMFS were the low-risk group (no risk factors), the mid-risk group (1 risk factor), and the high-risk group (2 or 3 risk factors), and the 3-year DMFS was 92.4%, 76.2%, and 64.6%, respectively (P = 0.001).
The prognosis was significantly poorer for patients with high-risk lymph node characteristics. Using this risk stratification, we should select the most appropriate and individualized treatment modality to improve outcomes in those patients with a poorer prognosis.
本研究的目的是确定盆腔淋巴结（PLN）特征的预后意义，并对局部晚期宫颈鳞状细胞癌同步放化疗患者进行风险分层。
我们回顾性分析了609例国际妇产科联盟（FIGO）II至IVa期接受同步放化疗患者的记录，比较有无PLN转移患者的总生存期（OS）、无远处转移生存期（DMFS）和无盆腔复发生存期。我们进一步分析了300例有PLN转移患者的OS和DMFS的预后因素，包括FIGO分期、肿瘤体积和淋巴结（LN）特征。
有或无PLN转移患者的3年OS率分别为81.7%和92.8%（P = 0.002），3年DMFS率分别为79.3%和92.7%（P = 0.006）。单因素分析显示，FIGO分期、LN体积、LN数量、LN直径以及融合/坏死LN均影响OS和DMFS。基于多因素分析，我们建立了一个风险分层模型。对于OS，独立危险因素为FIGO III或IVa期、LN体积≥3 cm、LN直径≥1.5 cm以及融合/坏死LN。低风险组（无危险因素）、中风险组（1或2个危险因素）和高风险组（3或4个危险因素）的3年OS率分别为96.6%、84.9%和64.7%（P = 0.005）。对于DMFS，LN直径≥1.5 cm、LN数量≥3个以及融合/坏死LN是独立危险因素。DMFS的亚组为低风险组（无危险因素）、中风险组（1个危险因素）和高风险组（2或3个危险因素），3年DMFS率分别为92.4%、76.2%和64.6%（P = 0.001）。
具有高风险淋巴结特征的患者预后明显较差。利用这种风险分层，我们应选择最合适的个体化治疗方式，以改善那些预后较差患者的治疗效果。
