Department of Radiation Therapy, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, Yunnan, China.
Department of Radiation Therapy, The Tumor Hospital of Yunnan Province, Kunming, 650118, Yunnan, China.
Arch Gynecol Obstet. 2021 Mar;303(3):793-801. doi: 10.1007/s00404-020-05826-6. Epub 2020 Oct 3.
To compare the survival outcome of neoadjuvant therapy (NAT) (chemotherapy or chemotherapy and intracavitary brachytherapy (ICBT) followed by radical surgery and of concomitant chemotherapy and radiotherapy (CCRT) in patients with locally advanced cervical adenocarcinoma and identify predictors of cervical adenocarcinoma.
We retrospectively reviewed our medical records of cervical adenocarcinoma patients treated with either NAT + surgery or CCRT in our institution from January 2013 to December 2017. The patients were treated with two-dimensional radiotherapy or three-dimensional-conformal or intensity-modulated radiotherapy combined with intracavitary brachytherapy. The regimen of concomitant chemotherapy was weekly cisplatin. The neoadjuvant chemotherapy (NACT) was paclitaxel plus cisplatin. The primary end points were overall survival (OS) and progression-free survival (PFS).
We enrolled 121 patients. There were 42 (34.7%) patients in the NAT + surgery group and 79 (65.3%) in the CCRT group. After univariate multivariate analysis, NAT was an independent predictor of OS (p = 0.008) and PFS (p = 0.006). After propensity score matching, the 5-year OS rates in the NAT + surgery and CCRT groups were 25% and 4%, respectively (p = 0.00014), and the 5-year PFS rates were 25% and 4%, respectively (p = 0.00015). Subgroup analysis showed that the 5-year OS and PFS rates in the NACT + surgery and CCRT groups were both 20% and 8%, respectively (p = 0.015).
Compared with CCRT, NAT followed by radical surgery had better OS and PFS in locally advanced cervical adenocarcinoma. In subgroup analysis, OS and PFS were longer for NACT + surgery than for CCRT.
比较局部晚期宫颈腺癌患者新辅助治疗（NAT）（化疗或化疗联合腔内近距离放疗（ICBT）后行根治性手术）和同期放化疗（CCRT）的生存结果，并确定宫颈腺癌的预测因素。
我们回顾性分析了 2013 年 1 月至 2017 年 12 月在我院接受治疗的局部晚期宫颈腺癌患者的病历资料。患者接受二维放疗、三维适形放疗或调强放疗联合腔内近距离放疗。同期化疗方案为每周顺铂。新辅助化疗（NACT）为紫杉醇联合顺铂。主要终点是总生存期（OS）和无进展生存期（PFS）。
共纳入 121 例患者。其中 42 例（34.7%）患者接受 NAT+手术治疗，79 例（65.3%）患者接受 CCRT 治疗。单因素和多因素分析显示，NAT 是 OS（p=0.008）和 PFS（p=0.006）的独立预测因素。在倾向评分匹配后，NAT+手术和 CCRT 两组的 5 年 OS 率分别为 25%和 4%（p=0.00014），5 年 PFS 率分别为 25%和 4%（p=0.00015）。亚组分析显示，NACT+手术和 CCRT 两组的 5 年 OS 和 PFS 率均为 20%和 8%（p=0.015）。
与 CCRT 相比，NAT 联合根治性手术治疗局部晚期宫颈腺癌患者的 OS 和 PFS 更好。在亚组分析中，NACT+手术组的 OS 和 PFS 均长于 CCRT 组。
