采用倾向评分匹配比较根治性子宫切除术治疗的大块 pTIIB 宫颈癌中腺癌与鳞癌的预后。
Prognosis of bulky pTIIB cervical cancer treated by radical hysterectomy comparing adenocarcinoma with squamous cell carcinoma using propensity score matching.
机构信息
Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Department of Biostatistics, Yamaguchi University, Ube, Yamaguchi, Japan.
出版信息
Int J Gynaecol Obstet. 2021 Apr;153(1):56-63. doi: 10.1002/ijgo.13451. Epub 2020 Dec 7.
OBJECTIVE
To investigate whether radical hysterectomy (RAH) can effectively treat true Stage IIB (pTIIB) cervical adenocarcinoma (AC) because FIGO (clinical) Stage IIB cervical cancer is rarely treated with RAH and radiotherapy has unfavorable effects on AC.
METHODS
We retrospectively analyzed data for 82 patients with Stage pTIIB cervical cancer who underwent RAH at our institution between January 1997 and December 2017. The end points were disease-free survival (DFS) and overall survival (OS) among squamous cell carcinoma (SCC) (n = 60) and AC (n = 22) patients. Kaplan-Meier survival analysis with and without propensity score matching was conducted to identify the impact of RAH.
RESULTS
Para-aortic lymph node metastasis and tumor diameter were significant factors for recurrence, and adjuvant chemotherapy prevented recurrence on multivariate analysis. After propensity score matching, there was no significant difference in DFS and OS between the groups. Five-year DFS and OS of the SCC group were 0.505 (95% confidence interval [CI] 0.268-0.702) and 0.619 (95% CI 0.351-0.803), respectively, and those of the AC group were 0.444 (95% CI 0.232-0.638) and 0.602 (95% CI 0.351-0.782), respectively.
CONCLUSION
Bulky Stage pTIIB cervical cancer is hard to cure, but RAH plus adjuvant therapy might be an option for radio-resistant pTIIB cervical AC.
目的
研究根治性子宫切除术（RAH）是否能有效治疗真正的ⅡB 期（pTIIB）宫颈腺癌（AC），因为 FIGO（临床）ⅡB 期宫颈癌很少采用 RAH 治疗，且放疗对 AC 效果不佳。
方法
我们回顾性分析了 1997 年 1 月至 2017 年 12 月期间在我院接受 RAH 的 82 例 pTIIB 期宫颈癌患者的数据。终点为鳞癌（SCC）（n=60）和 AC（n=22）患者的无病生存（DFS）和总生存（OS）。Kaplan-Meier 生存分析（包括和不包括倾向评分匹配）用于确定 RAH 的影响。
结果
腹主动脉旁淋巴结转移和肿瘤直径是复发的显著因素，辅助化疗在多变量分析中可预防复发。在倾向评分匹配后，两组之间的 DFS 和 OS 无显著差异。SCC 组的 5 年 DFS 和 OS 分别为 0.505（95%可信区间[CI] 0.268-0.702）和 0.619（95%CI 0.351-0.803），AC 组分别为 0.444（95%CI 0.232-0.638）和 0.602（95%CI 0.351-0.782）。
结论
体积较大的 pTIIB 期宫颈癌难以治愈，但 RAH 加辅助治疗可能是放射抗拒的 pTIIB 期宫颈 AC 的一种选择。
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