Nishio Shin, Matsuo Koji, Yonemoto Koji, Shimokawa Mototsugu, Hosaka Masayuki, Kodama Michiko, Miyake Takahito M, Ushijima Kimio, Kamura Toshiharu, Westin Shannon N, Soliman Pamela T, Coleman Robert L
Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Oncotarget. 2018 Aug 17;9(64):32321-32330. doi: 10.18632/oncotarget.25962.
Patients presenting with stage IVB cervical cancer pose a significant clinical challenge. While previous studies described several poor prognostic factors, they were limited by small sample sizes. The aim of this study was to identify clinicopathological prognostic factors in a large sample of patients with stage IVB cervical cancer at a single institution.
Patients with primary stage IVB cervical cancer diagnosed between 1992 and 2011 were extracted from a search of the MD Anderson Cancer Center registry. Clinicopathological data retrieved from their medical records included demographics (age and race), tumor characteristics (primary lesion size, grade, and histology), TNM classification, and metastatic site (nodal/organ). Treatment approach (radiation, chemotherapy, or both) and intent (palliation or curative) were recorded. Survival rates were evaluated using the Kaplan-Meier method. Cox proportional hazards regression was used to model the association between key variables and overall survival (OS).
Two hundred sixty-six patients with stage IVB cervical cancer were identified. Their median OS was 12.7 months. The hazard ratio for African-Americans vs. patients with other ethnicities was 1.76 (95% confidence interval [CI], 1.18-2.54, = 0.0063), and that for patients with para-aortic nodes alone vs. more extensive metastases was 0.37 (95% CI, 0.26-0.51, < 0.0001). Other clinicopathological factors were not significantly associated with survival.
African-American race was an independent adverse prognostic factor in this cohort. On the other hand, nodal disease in the para-aortic chain alone predicted a favorable prognosis.
IVB期宫颈癌患者带来了重大的临床挑战。虽然先前的研究描述了几个不良预后因素，但它们受到样本量小的限制。本研究的目的是在单一机构的大量IVB期宫颈癌患者样本中确定临床病理预后因素。
从MD安德森癌症中心登记处检索中提取1992年至2011年间诊断为原发性IVB期宫颈癌的患者。从他们的病历中检索到的临床病理数据包括人口统计学信息（年龄和种族）、肿瘤特征（原发灶大小、分级和组织学）、TNM分类和转移部位（淋巴结/器官）。记录治疗方法（放疗、化疗或两者皆用）和治疗意图（姑息性或根治性）。使用Kaplan-Meier方法评估生存率。采用Cox比例风险回归模型来模拟关键变量与总生存期（OS）之间的关联。
共确定了266例IVB期宫颈癌患者。他们的中位总生存期为12.7个月。非裔美国人与其他种族患者相比的风险比为1.76（95%置信区间[CI]，1.18 - 2.54，P = 0.0063），仅出现主动脉旁淋巴结转移的患者与转移范围更广的患者相比的风险比为0.37（95% CI，0.26 - 0.51，P < 0.0001）。其他临床病理因素与生存率无显著关联。
在该队列中，非裔美国人种族是一个独立的不良预后因素。另一方面，仅主动脉旁链出现淋巴结转移预示着良好的预后。
