Matsuzaki Shinya, Klar Maximilian, Mikami Mikio, Shimada Muneaki, Grubbs Brendan H, Fujiwara Keiichi, Roman Lynda D, Matsuo Koji
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue IRD520, Los Angeles, CA, 90033, USA.
Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany.
Curr Oncol Rep. 2020 Feb 12;22(3):28. doi: 10.1007/s11912-020-0888-x.
To review and discuss the present evidence of surgery- and radiation-based treatment strategies for stage IIB cervical cancer.
Recently, two randomized controlled trials compared the efficacy of neoadjuvant chemotherapy followed by radical hysterectomy (NACT + RH) with that of concurrent chemoradiotherapy (CCRT) for stage IB3-IIB cervical cancer. When these studies were combined (N = 1259), NACT + RH was associated with a shorter disease-free survival [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.13-1.64], but with a similar overall survival (HR 1.11, 95% CI 0.90-1.36) when compared with the findings for CCRT. Stage-specific analysis for stage IIB cervical cancer demonstrated that disease-free survival was significantly worse with NACT + RH than with CCRT (HR 1.90, 95% CI 1.25-2.89); however, no significant difference was observed for stage IB3-IIA cervical cancer. Based on the results of recent level I evidence, the standard treatment for stage IIB cervical cancer remains CCRT.
回顾并讨论目前关于IIB期宫颈癌基于手术和放疗的治疗策略的证据。
最近，两项随机对照试验比较了新辅助化疗后行根治性子宫切除术（NACT + RH）与同步放化疗（CCRT）治疗IB3-IIB期宫颈癌的疗效。当合并这些研究（N = 1259）时，与CCRT的结果相比，NACT + RH与无病生存期较短相关[风险比（HR）1.36，95%置信区间（CI）1.13 - 1.64]，但总生存期相似（HR 1.11，95%CI 0.90 - 1.36）。对IIB期宫颈癌的分期特异性分析表明，NACT + RH组的无病生存期显著差于CCRT组（HR 1.90，95%CI 1.25 - 2.89）；然而，IB3-IIA期宫颈癌未观察到显著差异。基于最近的I级证据结果，IIB期宫颈癌的标准治疗仍然是CCRT。
