Radiation Oncology, and.
Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, CA.
Int J Gynecol Cancer. 2018 Oct;28(8):1560-1568. doi: 10.1097/IGC.0000000000001323.
In this study, we analyzed patterns of care for patients with locally advanced cervical cancer to identify predictors for upfront surgery compared with definitive chemoradiation (CRT).
The National Cancer Database was queried for patients aged 18 years or older with Federation of Gynecology and Obstetrics IB2-IIB cervical cancer. All patients underwent either upfront hysterectomy with or without postoperative radiation therapy versus definitive CRT. Logistic regression was used to assess variables associated with modality of treatment (surgery vs CRT).
Of the 9494 patients included, 2151 (22.7%) underwent upfront surgery. Of those undergoing surgery, 380 (17.7%) had positive margins, 478 (22.2%) had positive nodes, and 458 (21.3%) had pathologic involvement of the parametrium. Under multiple logistic regression, rates of surgery significantly increased from 2004 (12.2%) to 2012 (31.2%) (odds ratio [OR] per year increase, 1.15; confidence interval [CI], 1.12-1.17; P < 0.001). Upfront surgery was more commonly performed in urban (OR, 1.21; 95% CI, 1.03-1.41; P = 0.018) and rural counties (OR, 1.79; 95% CI, 1.24-2.58; P = 0.002), for adenocarcinoma (OR, 2.14; 1.88-2.44; P < 0.001) and adenosquamous (OR, 2.69; 2.11-3.43; P < 0.001) histologies, and in patients from higher median income communities (ORs, 1.19-1.37). Upfront surgery was less common at academic centers (OR, 0.73; 95% CI, 0.58-0.93; P = 0.011).
Rates of upfront surgery relative to definitive CRT have increased significantly over the past decade. In the setting of level 1 evidence supporting the use of definitive CRT alone for these women, the rising rates of upfront surgery raises concern for both unnecessary surgical procedures with higher rates of treatment-related morbidity and greater health care costs.
本研究分析了局部晚期宫颈癌患者的治疗模式，以确定与根治性放化疗（CRT）相比行 upfront 手术的预测因素。
本研究通过国家癌症数据库对年龄在 18 岁及以上、FIGO 分期为 IB2-IIB 期的宫颈癌患者进行了检索。所有患者均接受 upfront 子宫切除术（包括术后放疗）或根治性 CRT。采用 logistic 回归分析评估与治疗方式（手术与 CRT）相关的变量。
在纳入的 9494 例患者中，有 2151 例（22.7%）接受 upfront 手术。在接受手术的患者中，有 380 例（17.7%）有阳性切缘，478 例（22.2%）有阳性淋巴结，458 例（21.3%）有宫旁组织受累。多因素 logistic 回归分析显示，自 2004 年（12.2%）以来，手术率显著增加（每年增加率为 1.15；95%CI，1.12-1.17；P < 0.001）。与城市（比值比 [OR]，1.21；95%CI，1.03-1.41；P = 0.018）和农村县（OR，1.79；95%CI，1.24-2.58；P = 0.002）相比， upfront 手术更常用于腺癌（OR，2.14；95%CI，1.88-2.44；P < 0.001）和腺鳞癌（OR，2.69；95%CI，2.11-3.43；P < 0.001）患者，以及来自中等收入社区的患者（OR，1.19-1.37）。与学术中心相比， upfront 手术在学术中心的发生率较低（OR，0.73；95%CI，0.58-0.93；P = 0.011）。
与根治性 CRT 相比， upfront 手术的比例在过去十年中显著增加。在有一级证据支持仅对这些女性使用根治性 CRT 的情况下， upfront 手术比例的上升令人担忧，因为这可能导致不必要的手术，增加治疗相关发病率和医疗费用。
