Departments of Radiation Oncology and.
Gynecologic Oncology, Aichi Cancer Center Hospital, Nagoya.
Int J Gynecol Cancer. 2018 Oct;28(8):1576-1583. doi: 10.1097/IGC.0000000000001336.
The aim of this study was to compare the outcomes and toxicities of radical hysterectomy (RH) and definitive chemoradiation (CRT) for International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer.
A retrospective analysis was performed on FIGO stage IIB patients who underwent RH with adjuvant radiotherapy (surgery group) or intended to receive CRT (CRT group). The distributions of disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Propensity score matching (PSM) was performed for the 2 groups based on age, tumor diameter, histological type, and pelvic node metastasis in pretreatment imaging tests.
Median follow-up times were 58 months in the surgery group (n = 75) and 55 months in the CRT group (n = 65). Propensity score matching identified 37 patients with similar characteristics from each group. Significant differences were observed in the ratio of the chemotherapy combination between the surgery and CRT groups before (47% vs 98%) and after PSM (51% vs 100%). Five-year DFS rates were slightly higher in the surgery group than in the CRT group before PSM (69% vs 58%, P = 0.30) but were similar after PSM (76% vs 82%, P = 0.36). Five-year OS rates were similar between the surgery and CRT groups before (70% vs 75%, P = 0.59) and after PSM (78% vs 77%, P = 0.97). The results of multivariate analyses also showed that neither DFS nor OS was associated with the treatment modalities regardless of PSM. The incidence of late toxicities grade 2 or greater was similar between the surgery and CRT groups before (17% vs 23%, P = 0.31) and after PSM (19% vs 24%, P = 0.78).
The results of this study suggest that RH with adjuvant radiotherapy and definitive CRT are equivalent treatment options for patients with FIGO stage IIB cancer. However, prospective larger studies are needed to confirm this.
本研究旨在比较国际妇产科联合会（FIGO）分期为 IIB 期宫颈癌行根治性子宫切除术（RH）与根治性放化疗（CRT）的结局和毒性。
对接受 RH 联合辅助放疗（手术组）或计划接受 CRT（CRT 组）的 FIGO IIB 期患者进行回顾性分析。采用 Kaplan-Meier 法计算无病生存率（DFS）和总生存率（OS）的分布。根据治疗前影像学检查中疾病无进展生存（DFS）和总体生存（OS）的年龄、肿瘤直径、组织学类型和盆腔淋巴结转移情况，对 2 组进行倾向评分匹配（PSM）。
手术组（n=75）中位随访时间为 58 个月，CRT 组（n=65）为 55 个月。PSM 后从每组各匹配 37 例具有相似特征的患者。手术组和 CRT 组化疗联合方案的比例在 PSM 前（47%比 98%）和 PSM 后（51%比 100%）差异有统计学意义。PSM 前手术组 5 年 DFS 率略高于 CRT 组（69%比 58%，P=0.30），但 PSM 后差异无统计学意义（76%比 82%，P=0.36）。PSM 前手术组和 CRT 组 5 年 OS 率相似（70%比 75%，P=0.59），PSM 后差异亦无统计学意义（78%比 77%，P=0.97）。多因素分析结果也显示，无论 PSM 与否，DFS 和 OS 均与治疗方式无关。PSM 前手术组和 CRT 组中晚期毒性≥2 级的发生率相似（17%比 23%，P=0.31），PSM 后差异亦无统计学意义（19%比 24%，P=0.78）。
本研究结果表明，RH 联合辅助放疗和根治性 CRT 是 FIGO IIB 期癌症患者的等效治疗选择。但需要更大规模的前瞻性研究来证实这一点。
