Seki Toshiyuki, Tanabe Hiroshi, Nagata Chie, Suzuki Jiro, Suzuki Kayo, Takano Hirokuni, Isonishi Seiji, Ochiai Kazuhiko, Takakura Satoshi, Okamoto Aikou
Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo.
Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa
Jpn J Clin Oncol. 2017 Jan;47(1):32-38. doi: 10.1093/jjco/hyw145. Epub 2016 Sep 27.
Patients with adeno/adenosquamous carcinoma may have a poorer prognosis than patients with squamous cell carcinoma. Radiotherapy and concurrent chemoradiotherapy are used as adjuvant therapies for cervical cancer, regardless of the histological subtype. The aim of this study was to investigate the prognostic outcome of adjuvant therapy for patients with adeno/adenosquamous carcinoma with pathological risk factors.
The medical records of 135 patients with stage IB-IIB cervical cancer with squamous cell carcinoma or adeno/adenosquamous carcinoma who underwent primary surgery followed by adjuvant therapy were retrospectively reviewed. Patients with a pathologically confirmed bulky tumor (≥4 cm), nodal metastasis and/or parametrium invasion were included in the study.
The median follow-up period was 48 (1-132) months. Of the 135 patients, 90 with squamous cell carcinoma and 23 with adeno/adenosquamous carcinoma were treated with adjuvant radiotherapy and concurrent chemoradiotherapy (SCC-RT/CCRT and AC-RT/CCRT groups), and 22 with adeno/adenosquamous carcinoma were treated with adjuvant systemic chemotherapy (AC-CT group). There were no significant differences in clinicopathological factors between the SCC-RT/CCRT and AC-RT/CCRT groups and between the AC-RT/CCRT and AC-CT groups. Progression-free survival was significantly shorter in the AC-RT/CCRT group compared to the SCC-RT/CCRT group (P = 0.002). Adeno/adenosquamous carcinoma histology and multiple lymph node metastasis were independent prognostic factors for shorter progression-free survival in patients treated with adjuvant radiotherapy and concurrent chemoradiotherapy. Progression-free survival was also significantly shorter in the AC-RT/CCRT group compared to the AC-CT group (P = 0.026).
Adjuvant radiotherapy and concurrent chemoradiotherapy may be less effective for patients with adeno/adenosquamous carcinoma than for those with squamous cell carcinoma. Adjuvant systemic chemotherapy may be beneficial for adeno/adenosquamous carcinoma and further studies are warranted.
腺/腺鳞癌患者的预后可能比鳞状细胞癌患者更差。放疗和同步放化疗被用作宫颈癌的辅助治疗，无论组织学亚型如何。本研究的目的是调查伴有病理危险因素的腺/腺鳞癌患者辅助治疗的预后结果。
回顾性分析135例IB-IIB期宫颈癌患者的病历，这些患者接受了原发性手术，随后接受辅助治疗，病理类型为鳞状细胞癌或腺/腺鳞癌。研究纳入了病理证实为大块肿瘤（≥4cm）、淋巴结转移和/或宫旁浸润的患者。
中位随访期为48（1-132）个月。135例患者中，90例鳞状细胞癌患者和23例腺/腺鳞癌患者接受了辅助放疗和同步放化疗（SCC-RT/CCRT组和AC-RT/CCRT组），22例腺/腺鳞癌患者接受了辅助全身化疗（AC-CT组）。SCC-RT/CCRT组与AC-RT/CCRT组之间以及AC-RT/CCRT组与AC-CT组之间的临床病理因素无显著差异。与SCC-RT/CCRT组相比，AC-RT/CCRT组的无进展生存期显著缩短（P = 0.002）。腺/腺鳞癌组织学类型和多发淋巴结转移是接受辅助放疗和同步放化疗患者无进展生存期缩短的独立预后因素。与AC-CT组相比，AC-RT/CCRT组的无进展生存期也显著缩短（P = 0.026）。
辅助放疗和同步放化疗对腺/腺鳞癌患者的疗效可能低于鳞状细胞癌患者。辅助全身化疗可能对腺/腺鳞癌有益，值得进一步研究。
