Derks Marloes, Groenman Freek A, van Lonkhuijzen Luc R C W, Schut Paulien C, Westerveld Henrike, van der Velden Jacobus, Kenter Gemma G
*Center for Gynecologic Oncology Amsterdam, Academic Medical Center; †Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute; and ‡Department of Radiotherapy, Academic Medical Center, Amsterdam, the Netherlands.
Int J Gynecol Cancer. 2017 Jun;27(5):1015-1020. doi: 10.1097/IGC.0000000000000974.
Management regarding completing hysterectomy in case of intraoperative finding of positive lymph nodes in early-stage cervical cancer differs between institutions. The aim of this study was to compare survival and toxicity after completed hysterectomy followed by adjuvant (chemo-)radiotherapy versus abandoned hysterectomy and primary treatment with chemoradiotherapy (CRT).
A retrospective multicenter cohort study was performed. All patients were scheduled for radical hysterectomy with pelvic lymphadenectomy (RHL). In the RHL group, hysterectomy was completed followed by adjuvant (chemo-)radiotherapy. In the second group, hysterectomy was abandoned, and CRT was conducted. Primary outcomes were disease-free survival (DFS) and overall survival. A multivariable analysis on DFS was performed. Toxicity was scored according to the National Cancer Institute CTCAE (Common Terminology Criteria for Adverse Events) v4.03.
A total of 121 patients were included (RHL, n = 89; CRT, n = 32). There was no difference in overall survival (84% vs 77%). Five-year DFS was in favor of completing RHL (81% vs 67%). Multivariable analysis showed that, corrected for lymph node variables, treatment regimen was not associated with DFS. After RHL, pelvic recurrence rate was significantly lower compared with CRT (2% vs 16%). CTCAE grade 3-4 toxicity rates were higher in the CRT compared with the RHL group (59% vs 30%), mainly because of differences in chemotherapy-related hematologic toxicity.
In patients with clinically N0 early-stage cervical cancer with intraoperative detection of positive nodes, completing RHL followed by adjuvant (chemo-)radiotherapy may result in a better pelvic control compared with abandoning hysterectomy and treatment with chemoradiotherapy. However, if corrected for lymph node variables, treatment (RHL or CRT) was not associated with DFS.
对于早期宫颈癌术中发现淋巴结阳性时完成子宫切除术的管理，不同机构存在差异。本研究的目的是比较完成子宫切除术后辅助（化疗）放疗与放弃子宫切除术并采用放化疗（CRT）作为初始治疗后的生存率和毒性。
进行了一项回顾性多中心队列研究。所有患者均计划行根治性子宫切除术加盆腔淋巴结清扫术（RHL）。在RHL组中，完成子宫切除术后进行辅助（化疗）放疗。在第二组中，放弃子宫切除术并进行CRT。主要结局是无病生存期（DFS）和总生存期。对DFS进行了多变量分析。毒性根据美国国立癌症研究所CTCAE（不良事件通用术语标准）v4.03进行评分。
共纳入121例患者（RHL组，n = 89；CRT组，n = 32）。总生存期无差异（84%对77%）。5年DFS有利于完成RHL（81%对67%）。多变量分析显示，校正淋巴结变量后，治疗方案与DFS无关。RHL后盆腔复发率显著低于CRT（2%对16%）。与RHL组相比，CRT组的CTCAE 3 - 4级毒性率更高（59%对30%），主要是因为化疗相关血液学毒性存在差异。
对于临床N0期早期宫颈癌术中检测到淋巴结阳性的患者，与放弃子宫切除术并采用放化疗相比，完成RHL后辅助（化疗）放疗可能导致更好的盆腔控制。然而，校正淋巴结变量后，治疗（RHL或CRT）与DFS无关。
