Department of Gynecological Oncology, Istanbul University, Fatih, Istanbul, Turkey.
Rev Bras Ginecol Obstet. 2020 Jan;42(1):35-42. doi: 10.1055/s-0040-1701459. Epub 2020 Feb 27.
To evaluate the outcomes of surgical treatment in patients with chemoradiotherapy (CRT)-resistant and locally advanced cervical cancer (LACC).
Patients with LACC who underwent surgery due to resistance to CRT between 2005 and 2015 were reviewed retrospectively. Disease-free survival (DFS) and overall survival (OS) related factors were analyzed.
A total of 23 patients were included in the study and the median age was 51 years old. A total of 14 patients (60.8%) experienced recurrence; among these recurrences, 8 of them were local, 5 were distant, 1 was both distant and local. A total of 9 patients (39%) died. The Median DFS and OS durations were 15 and 32 months, respectively. A total of 17 patients (74%) had undergone simple hysterectomy, 4 (17%) radical hysterectomy, and 2 (9%) total pelvic exenteration. Postoperative grade 3 and 4 complications were seen in 12 patients (52%). Macroscopic tumor presence in the pathology specimen was associated with distant recurrence and positive surgical margins with local recurrence (Log-Rank test = 0.029 and = 0.048, respectively). The only factor associated with OS was surgical margin positivity (Log-Rank test = 0.008). The type of surgery, grades 3 and 4 postoperative complications, brachytherapy, and tumor histology were not associated with recurrence.
In patients with LACC, hysterectomy is an option in the presence of a central residual tumor after CRT. However, the risk of grades 3 and 4 complications of performed surgery is high. The presence of macroscopic tumor in the pathology specimen and positive surgical margins are poor prognostic factors. The goal of the surgeon should be to achieve a negative surgical margin. It does not seem important if the surgery is simple or radical.
评估放化疗（CRT）抵抗和局部晚期宫颈癌（LACC）患者手术治疗的结局。
回顾性分析 2005 年至 2015 年间因 CRT 抵抗而行手术的 LACC 患者。分析无病生存（DFS）和总生存（OS）相关因素。
共纳入 23 例患者，中位年龄 51 岁。共有 14 例（60.8%）患者复发；其中 8 例为局部复发，5 例为远处转移，1 例为局部和远处转移。共有 9 例（39%）患者死亡。中位 DFS 和 OS 分别为 15 个月和 32 个月。17 例（74%）患者行单纯子宫切除术，4 例（17%）行根治性子宫切除术，2 例（9%）行全盆腔切除术。术后有 12 例（52%）患者发生 3 级和 4 级并发症。病理标本中存在肉眼肿瘤与远处复发和手术切缘阳性与局部复发相关（Log-Rank 检验分别为 0.029 和 0.048）。与 OS 相关的唯一因素是手术切缘阳性（Log-Rank 检验为 0.008）。手术类型、3 级和 4 级术后并发症、近距离放疗和肿瘤组织学与复发无关。
对于 LACC 患者，在 CRT 后中央肿瘤残留的情况下，子宫切除术是一种选择。然而，术后发生 3 级和 4 级并发症的风险较高。病理标本中存在肉眼肿瘤和手术切缘阳性是预后不良的因素。外科医生的目标应该是达到阴性手术切缘。手术是简单还是根治性并不重要。
