Zhao Deying, Qiu Hui, Zhang Hui, Hong L, Zhang Gong, Xie Conghua
Department of Medical Oncology, Huanggang Central Hospital.
Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University; Cancer Clinical Study Center of Hubei Province; Hubei Key Laboratory of Tumor Biological Behavior, Hubei, China.
Jpn J Clin Oncol. 2017 Nov 1;47(11):1024-1030. doi: 10.1093/jjco/hyx127.
The aim of the present retrospective analysis was to determine the effectiveness of pelvic radiotherapy (RT) as postoperative adjuvant therapy for low-risk cervical cancer.
Between June 2003 and April 2011, the clinical data of 225 International Federation of Gynecology and Obstetrics (FIGO) Stage IB1-IIA cervical cancer patients with low-risk factors were retrospectively reviewed, to analyze the relationship between adjuvant pelvic RT after radical hysterectomy and tumor recurrence or the patients' survival.
The 5-year overall survival (OS) of 225 patients was 91.2% and 5-year disease-free survival (DFS) was 84.5%. The 5-year DFS and local regional disease-free survival was significantly better for patients in the RT group compared with that in the non-RT group (5-year DFS, 91.2% vs. 77.1%, P = 0.006; 5-year local regional disease-free survival 94.6% vs. 79.0%, P = 0.001). There were no statistically significant differences in the 5-year OS (92.9% vs. 89.4%, P = 0.371) and distant metastasis-free survival (96.4% vs. 96.5%, P = 0.887) between the two groups. Grade 3-4 treatment-related acute and late toxicities were not significantly different between the two groups. Subgroup analysis shows the 5-year DFS of RT alone, chemotherapy (CT) alone, non-RT/CT, RT and CT was, respectively, 90.5%, 62.9%, 81.4%, 92.5% separately (P = 0.002). The 5-year OS was not significantly different (91.6% vs. 78.2% vs. 92.9% vs. 96.9%, P = 0.887) between the four groups. Performing univariate analysis, postoperative CT was the only significant risk factor for DFS.
Our results indicate that postoperative adjuvant pelvic RT has a tendency to improve DFS especially local regional disease-free survival for FIGO Stage IB1-IIA cervical cancer patients with low-risk factors, without increased Grade 3-4 treatment-related acute and late toxicities, but non-standard CT is harmful to the prognosis (DFS) of these patients.
本回顾性分析旨在确定盆腔放疗（RT）作为低风险宫颈癌术后辅助治疗的有效性。
回顾性分析2003年6月至2011年4月期间225例国际妇产科联盟（FIGO）IB1-IIA期低风险因素宫颈癌患者的临床资料，分析根治性子宫切除术后辅助盆腔放疗与肿瘤复发或患者生存之间的关系。
225例患者的5年总生存率（OS）为91.2%，5年无病生存率（DFS）为84.5%。RT组患者的5年DFS和局部区域无病生存率显著优于非RT组（5年DFS，91.2%对77.1%，P = 0.006；5年局部区域无病生存率94.6%对79.0%，P = 0.001）。两组之间的5年OS（92.9%对89.4%，P = 0.371）和无远处转移生存率（96.4%对96.5%，P = 0.887）无统计学显著差异。两组之间3-4级治疗相关的急性和晚期毒性无显著差异。亚组分析显示，单纯RT、单纯化疗（CT）、非RT/CT、RT联合CT的5年DFS分别为90.5%、62.9%、81.4%、92.5%（P = 0.002）。四组之间的5年OS无显著差异（91.6%对78.2%对92.9%对96.9%，P = 0.887）。进行单因素分析，术后CT是DFS的唯一显著危险因素。
我们的结果表明，术后辅助盆腔放疗有改善低风险因素的FIGO IB1-IIA期宫颈癌患者DFS尤其是局部区域无病生存率的趋势，且不增加3-4级治疗相关的急性和晚期毒性，但非标准CT对这些患者的预后（DFS）有害。
