Khulpateea Beman Roy, Paulson Annette, Carlson Matthew, Miller David Scott, Lea Jayanthi
Gynecologic Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
Gynecologic Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Int J Gynecol Cancer. 2021 Apr;31(4):518-523. doi: 10.1136/ijgc-2019-000386. Epub 2020 Sep 12.
Stage IVA cervical cancer is an uncommon diagnosis. The course of the disease and the complications of treatment are not well characterized. The goal of this study was to report treatment outcomes of patients with stage IVA cervical cancer.
A single institution retrospective review was carried out of all patients treated for stage IVA cervical cancer from January 2008 to July 2017. Patients were clinically staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 staging criteria for cervical cancer. Inclusion criteria were patients with stage IVA cervical cancer of any histologic subtype, including patients with evidence of para-aortic lymph node involvement, treated at the institution during this time period. Overall survival and progression free survival were calculated using the Kaplan-Meyer method. Comparisons between survival were done using the Cox proportional hazards regression model and the log rank test.
We identified 25 patients with stage IVA cervical cancer. Mean age at diagnosis was 54 years (range 27-77). Squamous cell carcinoma was the histologic diagnosis in 24 of 25 patients (96%), with 1 case of small cell carcinoma (4%). 21 patients completed a full course of radiation. The median overall survival for patients who completed their treatment was 60 months (range 3-136), with a 2 year overall survival of 63%. The median progression free survival was 27 months (range 0-125), with a 2 year progression free survival of 40%. 11 of 25 patients (44%) developed fistulas during the course of their disease, and 55% of these were complex fistulas. 19 of 25 (76%) patients had a percutaneous nephrostomy for either hydronephrosis or diversion of vesicovaginal fistula. 111 unplanned admissions occurred among the 25 patients, and infections of the urinary tract was implicated in 46 (41%) of these. The cohort had a total of 92 emergency department visits, with pain control (36%) and medication refills (15%) being the most common presentations.
Patients with stage IVA cervical cancer may have substantial long term survival, although the sequelae of disease and treatment is associated with significant morbidity. Symptoms of fistula, percutaneous nephrostomy complications, and chronic pain present unique issues that require extensive supportive care.
IVA期宫颈癌是一种罕见的诊断。该疾病的病程和治疗并发症尚未得到充分描述。本研究的目的是报告IVA期宫颈癌患者的治疗结果。
对2008年1月至2017年7月期间接受IVA期宫颈癌治疗的所有患者进行单机构回顾性研究。患者根据国际妇产科联盟（FIGO）2009年宫颈癌分期标准进行临床分期。纳入标准为在此期间在该机构接受治疗的任何组织学亚型的IVA期宫颈癌患者，包括有腹主动脉旁淋巴结受累证据的患者。使用Kaplan-Meier方法计算总生存期和无进展生存期。使用Cox比例风险回归模型和对数秩检验进行生存比较。
我们确定了25例IVA期宫颈癌患者。诊断时的平均年龄为54岁（范围27 - 77岁）。25例患者中有24例（96%）的组织学诊断为鳞状细胞癌，1例为小细胞癌（4%）。21例患者完成了全程放疗。完成治疗的患者的中位总生存期为60个月（范围3 - 136个月），2年总生存率为63%。中位无进展生存期为27个月（范围0 - 125个月），2年无进展生存率为40%。25例患者中有11例（44%）在病程中出现瘘管，其中55%为复杂性瘘管。25例患者中有19例（76%）因肾积水或膀胱阴道瘘引流而进行了经皮肾造瘘术。25例患者共发生111次非计划住院，其中46次（41%）与尿路感染有关。该队列共有92次急诊就诊，最常见的情况是疼痛控制（36%）和药物续方（15%）。
IVA期宫颈癌患者可能有较长的长期生存期，尽管疾病和治疗的后遗症与显著的发病率相关。瘘管症状、经皮肾造瘘术并发症和慢性疼痛带来了需要广泛支持治疗的独特问题。
