Jhawar Sachin, Hathout Lara, Elshaikh Mohamed A, Beriwal Sushil, Small William, Mahmoud Omar
Department of Radiation Oncology, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.
Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan.
Int J Radiat Oncol Biol Phys. 2017 Aug 1;98(5):1132-1141. doi: 10.1016/j.ijrobp.2017.03.045. Epub 2017 Mar 31.
Worse treatment outcomes can be expected with prolongation of the overall treatment time (OTT) during definitive chemoradiation therapy (CRT) for cervical cancer. In the adjuvant setting, data on the relative importance of the OTT and the importance of RT and chemotherapy synchronization are scarce. Using the National Cancer Database, we evaluated the effect of these treatment variables on overall survival in the adjuvant CRT setting.
The present analysis included nonmetastatic cervical cancer patients undergoing hysterectomy followed by adjuvant CRT. The proportional hazard model was used to estimate the effect of prognostic factors (age, comorbidity, race, tumor size, tumor grade, tumor histologic type, number of high-risk pathologic factors) and time-related variables (surgery to RT start interval [SR], OTT [RT start to end dates], package time [from diagnosis date to CRT end date] and optimum CRT synchronization [whether chemotherapy and RT start dates coincided]) on survival.
Of 3051 patients, 60% finished RT within 7 weeks and 85% received optimum CRT. Among other factors, univariate analysis identified longer OTT (hazards ratio [HR] 1.33; P<.001), longer SR (HR 1.17; P=.05), and nonoptimum CRT timing (HR 1.21; P=.04) as poor prognosticators. Of these factors, SR (HR 1.20; P=.04) and OTT (HR 1.21; P=.002) retained significance on multivariate analysis. An OTT >7 weeks remained a significant factor even after propensity score matching (P=.04).
The results of our analysis suggest that prolongation of the adjuvant CRT duration >7 weeks is associated with poor survival and SR of <8 weeks should be attempted whenever clinically feasible.
在宫颈癌的根治性放化疗（CRT）期间，总体治疗时间（OTT）延长可能导致更差的治疗结果。在辅助治疗中，关于OTT的相对重要性以及放疗和化疗同步性的重要性的数据较少。利用国家癌症数据库，我们评估了这些治疗变量对辅助CRT环境下总生存期的影响。
本分析纳入了接受子宫切除术后辅助CRT的非转移性宫颈癌患者。采用比例风险模型来估计预后因素（年龄、合并症、种族、肿瘤大小、肿瘤分级、肿瘤组织学类型、高危病理因素数量）和时间相关变量（手术至放疗开始间隔时间[SR]、OTT[放疗开始至结束日期]、总治疗时间[从诊断日期至CRT结束日期]以及最佳CRT同步性[化疗和放疗开始日期是否一致]）对生存的影响。
在3051例患者中，60%在7周内完成放疗，85%接受了最佳CRT。在其他因素中，单因素分析确定OTT延长（风险比[HR]1.33；P<.001）、SR延长（HR 1.17；P=.05）和CRT时机不佳（HR 1.21；P=.04）为不良预后因素。在这些因素中，SR（HR 1.20；P=.04）和OTT（HR 1.21；P=.002）在多因素分析中仍具有显著性。即使在倾向得分匹配后，OTT>7周仍是一个显著因素（P=.04）。
我们的分析结果表明，辅助CRT持续时间延长>7周与生存率低相关，并且只要临床可行，应尝试使SR<8周。
