Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
Int J Gynecol Cancer. 2022 Jan;32(1):21-27. doi: 10.1136/ijgc-2020-001230. Epub 2020 May 30.
OBJECTIVE: The benefit of adjuvant chemotherapy after definitive chemoradiotherapy in patients with pelvic lymph node-positive cervical cancer has been poorly studied. This study aimed to test the hypothesis that the addition of adjuvant chemotherapy to definitive radiotherapy or concurrent chemoradiotherapy improves survival in patients with pelvic lymph node-positive cervical squamous cell carcinoma. METHODS: This retrospective study enrolled patients with stage IB-IVA pelvic lymph node-positive cervical squamous cell carcinoma, without para-aortic lymph node metastases and initially treated with definitive radiotherapy or concurrent chemoradiotherapy between March 2007 and February 2018. Patients were classified into the adjuvant chemotherapy (5-fluorouracil or paclitaxel, plus cisplatin) and no-adjuvant chemotherapy groups. Treatment outcomes were compared between the two groups before and after 1:1 ratio propensity score matching. RESULTS: Medical records of 951 patients were reviewed and 792 patients were excluded. Finally, 159 patients were enrolled for analysis. Of these, 42 patients received a median of two cycles (range, 1-6) of adjuvant chemotherapy and 117 patients under observation after primary treatment. The median follow-up period was 33.8 months (range, 2.9-113.0). Before propensity score matching, no significant difference was observed in survivals between the two groups (P>0.05). After propensity score matching, 37 pairs of patients were selected. The 3-year rates of progression-free survival, overall survival, local control, and distant metastasis-free survival in the adjuvant chemotherapy and no-adjuvant chemotherapy groups were 80.2% and 60.4% (P=0.07), 83.0% and 63.7% (P=0.17), 94.0% and 81.9% (P=0.12), and 85.9% and 60.1% (P=0.04), respectively. The incidences of grade 3-4 acute and late toxicities were comparable between the two groups (P>0.05). DISCUSSION: Adjuvant chemotherapy significantly improved 3-year distant metastasis-free survival in patients with pelvic lymph node-positive cervical squamous cell carcinoma. Further prospective studies are needed to provide supportive evidence for the therapeutic efficacy of adjuvant chemotherapy.
目的：辅助化疗在盆腔淋巴结阳性宫颈癌患者根治性放化疗后的获益尚未得到充分研究。本研究旨在检验辅助化疗联合根治性放疗或同期放化疗是否能提高盆腔淋巴结阳性宫颈鳞癌患者的生存这一假设。
方法：本回顾性研究纳入了 2007 年 3 月至 2018 年 2 月期间接受根治性放疗或同期放化疗治疗的盆腔淋巴结阳性、无主动脉旁淋巴结转移的ⅠB-IVA 期宫颈鳞癌患者。患者分为辅助化疗（氟尿嘧啶或紫杉醇加顺铂）和无辅助化疗组。在 1:1 比例倾向评分匹配前后比较两组的治疗结果。
结果：共回顾了 951 例患者的病历，排除了 792 例患者，最终纳入 159 例患者进行分析。其中 42 例患者接受了中位数为 2 个周期（范围 1-6 个周期）的辅助化疗，117 例患者在初始治疗后进行观察。中位随访时间为 33.8 个月（范围 2.9-113.0 个月）。在倾向评分匹配前，两组患者的生存情况无显著差异（P＞0.05）。在倾向评分匹配后，选择了 37 对患者。辅助化疗组和无辅助化疗组的 3 年无进展生存率、总生存率、局部控制率和无远处转移生存率分别为 80.2%和 60.4%（P=0.07）、83.0%和 63.7%（P=0.17）、94.0%和 81.9%（P=0.12）和 85.9%和 60.1%（P=0.04）。两组患者 3 级及以上急性和晚期毒性发生率相当（P＞0.05）。
讨论：辅助化疗显著提高了盆腔淋巴结阳性宫颈鳞癌患者的 3 年无远处转移生存率。需要进一步的前瞻性研究为辅助化疗的治疗效果提供支持证据。
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