Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China.
Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China.
Sci Rep. 2017 Jun 9;7(1):3175. doi: 10.1038/s41598-017-03580-5.
The aim of this study was to investigate the impact of local treatment modalities on the survival of patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIB cervical cancer, including cancer-directed surgery (CDS) alone and CDS combined with radiotherapy (RT). A total of 8,357 patients with cervical cancer between 1988 and 2013 were included in the final study cohort, including 4,298 (51.4%) patients who underwent CDS alone and 4,059 (48.6%) patients who received combination therapy. Univariate and multivariate analyses showed that local treatment modalities were prognostic factors for cause-specific survival (CSS). Patients who received combination therapy had worse CSS (HR = 1.38; 95% CI = 1.20-1.59; P < 0.001). Subgroup analyses showed the prognostic effect of local treatment modalities was significantly influenced by FIGO stage. In the propensity-score matched (PSM) dataset, CDS was associated with better CSS (P < 0.001) for patients with IB-IIA cervical cancer; nevertheless, no differences were observed in CSS (P = 0.639) for patients with IIB cervical cancer. In conclusion, radical surgery was the preferred treatment for patients with IB-IIA cervical cancer, and there was no difference between radical surgery alone and combination therapy for patients with IIB cervical cancer.
本研究旨在探讨局部治疗方式对国际妇产科联合会（FIGO）分期 IB-IIB 宫颈癌患者生存的影响，包括单纯癌症定向手术（CDS）和 CDS 联合放疗（RT）。最终研究队列纳入了 1988 年至 2013 年间的 8357 例宫颈癌患者，其中 4298 例（51.4%）患者接受单纯 CDS，4059 例（48.6%）患者接受联合治疗。单因素和多因素分析表明，局部治疗方式是影响特定原因生存（CSS）的预后因素。接受联合治疗的患者 CSS 更差（HR=1.38；95%CI=1.20-1.59；P<0.001）。亚组分析显示，局部治疗方式的预后效应明显受 FIGO 分期的影响。在倾向评分匹配（PSM）数据集，CDS 与 IB-IIA 期宫颈癌患者的 CSS 更好相关（P<0.001）；然而，对于 IIB 期宫颈癌患者，CSS 无差异（P=0.639）。总之，根治性手术是 IB-IIA 期宫颈癌患者的首选治疗方法，而对于 IIB 期宫颈癌患者，根治性手术单独与联合治疗之间无差异。
