Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA.
Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
J Gynecol Oncol. 2019 May;30(3):e41. doi: 10.3802/jgo.2019.30.e41.
Adjuvant hysterectomy following chemoradiation (CRT) is a treatment option used worldwide for early-stage cervical cancer but the benefit of hysterectomy in this setting is unclear. An analysis of the National Cancer Database (NCDB) was performed to identify patterns of care and determine the survival impact of adjuvant hysterectomy.
The NCDB was queried for patients with International Federation of Gynecology and Obstetrics stage IB2 to IIA2 cervical cancer diagnosed from 2010-2014 who underwent preoperative concurrent chemoradiation followed by hysterectomy (CRT+S) or definitive CRT. Overall survival (OS) curves were generated using the Kaplan-Meier method and compared via the log-rank test. Univariable and multivariable logistic regression and Cox regression were used to determine covariables associated with utilization and OS.
There were 1,546 patients who met the study criteria, of which 1,407 (91.0%) received concurrent CRT alone and 139 (9.0%) received CRT+S. Four-year OS for the CRT+S group was 82.2% and 74.9% for the CRT group (p=0.036). On subgroup analysis by lymph node status, the 4-year OS for patients without positive pelvic or para-aortic lymph nodes was 84.9% in the CRT+S group vs. 77.8% in the CRT group (p=0.072). On multivariable Cox regression, there was no difference in survival based on treatment group (hazard ratio=0.63; 95% confidence interval=0.06-1.04; p=0.069).
We found from this hospital database that completion hysterectomy is used infrequently and did not result in a significant survival difference when accounting for other factors.
在放化疗（CRT）后进行辅助子宫切除术是全球用于治疗早期宫颈癌的一种治疗选择，但这种情况下子宫切除术的益处尚不清楚。对国家癌症数据库（NCDB）进行了分析，以确定治疗模式，并确定辅助子宫切除术对生存的影响。
从 2010 年至 2014 年，对 NCDB 进行了国际妇产科联合会（FIGO）分期为 IB2 至 IIA2 的宫颈癌患者的查询，这些患者接受了术前同步放化疗后行子宫切除术（CRT+S）或根治性 CRT。使用 Kaplan-Meier 方法生成总生存（OS）曲线，并通过对数秩检验进行比较。使用单变量和多变量逻辑回归和 Cox 回归来确定与使用率和 OS 相关的协变量。
共有 1546 名符合研究标准的患者，其中 1407 名（91.0%）接受了单纯同步 CRT，139 名（9.0%）接受了 CRT+S。CRT+S 组的 4 年 OS 为 82.2%，CRT 组为 74.9%（p=0.036）。按淋巴结状态进行亚组分析，无盆腔或主动脉旁淋巴结阳性的患者在 CRT+S 组的 4 年 OS 为 84.9%，在 CRT 组为 77.8%（p=0.072）。多变量 Cox 回归分析显示，两组之间的生存无差异（风险比=0.63；95%置信区间=0.06-1.04；p=0.069）。
从这个医院数据库中我们发现，完成子宫切除术的使用率较低，且在考虑其他因素时，与生存无显著差异。
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