Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Department of Radiation Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Pract Radiat Oncol. 2018 Nov-Dec;8(6):e377-e385. doi: 10.1016/j.prro.2018.05.010. Epub 2018 May 26.
Definitive local therapy is often used in metastatic cervical cancer to reduce morbidity associated with local tumor progression. However, the potential benefit of this therapeutic approach has not been rigorously investigated. We hypothesized that definitive local therapy is associated with improved overall survival (OS) in metastatic cervical cancer.
Patients aged ≥18 years with newly diagnosed metastatic cervical cancer who were treated with chemotherapy were identified from the National Cancer Database. Patients were dichotomized into the following cohorts: definitive local therapy (defined as either concurrent chemoradiation therapy or definitive surgery) or conservative therapy (defined as systemic therapy with or without palliative radiation therapy). The association between definitive local therapy and OS was assessed using propensity score-weighted Cox proportional hazards models. Potential unmeasured confounding was assessed through sensitivity analyses. Factors associated with the receipt of definitive local therapy were identified with multivariable logistic regression.
A total of 2838 patients were identified, of whom 1194 (42%) and 1644 (58%) were treated with definitive local and conservative therapy, respectively. Receipt of definitive local therapy was statistically significant, associated with less comorbidity, lower clinical T stage, and node negative disease. Compared with conservative therapy, definitive local therapy was associated with improved OS (hazard ratio: 0.57; 95% confidence interval, 0.52-0.62; P ≤ .001). The median OS rate was 19.2 months in the definitive local therapy cohort and 10.1 months in the conservative therapy cohort. These findings were robust to potential unmeasured confounding in sensitivity analyses and on landmark analyses of patients who survived at least 12 months (hazard ratio: 0.71; 95% confidence interval, 0.62-0.82; P ≤ .001).
Definitive local therapy is associated with improved OS in patients with metastatic cervical cancer. These findings suggest a novel setting for the use of definitive local therapy in the metastatic setting.
在转移性宫颈癌中，通常采用确定性局部治疗以减少与局部肿瘤进展相关的发病率。然而，这种治疗方法的潜在益处尚未得到严格研究。我们假设确定性局部治疗与转移性宫颈癌患者的总生存（OS）改善相关。
从国家癌症数据库中确定了年龄≥18 岁、新诊断为转移性宫颈癌且接受化疗的患者。将患者分为以下两组：确定性局部治疗（定义为同步放化疗或确定性手术）或保守治疗（定义为全身治疗加或不加姑息性放疗）。使用倾向评分加权 Cox 比例风险模型评估确定性局部治疗与 OS 之间的关联。通过敏感性分析评估潜在的未测量混杂因素。使用多变量逻辑回归识别与接受确定性局部治疗相关的因素。
共确定了 2838 例患者，其中 1194 例（42%）和 1644 例（58%）分别接受了确定性局部治疗和保守治疗。接受确定性局部治疗与较少的合并症、较低的临床 T 分期和淋巴结阴性疾病相关，且具有统计学意义。与保守治疗相比，确定性局部治疗与 OS 改善相关（风险比：0.57；95%置信区间，0.52-0.62；P ≤.001）。在确定性局部治疗组中，中位 OS 率为 19.2 个月，在保守治疗组中为 10.1 个月。这些发现在敏感性分析和至少存活 12 个月的患者的里程碑分析中是稳健的（风险比：0.71；95%置信区间，0.62-0.82；P ≤.001）。
在转移性宫颈癌患者中，确定性局部治疗与 OS 改善相关。这些发现提示在转移性疾病中使用确定性局部治疗的新方法。
