Kang Jun-Hyeok, Cho Won Kyung, Yeo Hie Jun, Jeong Soo Young, Noh Joseph J, Shim Jung In, Lee Yoo-Young, Kim Tae-Joong, Lee Jeong-Won, Kim Byoung-Gie, Bae Duk-Soo, Park Won, Choi Chel Hun
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
J Clin Med. 2020 Oct 28;9(11):3471. doi: 10.3390/jcm9113471.
This study aimed to evaluate the prognostic significance of tumor regression rate according to radiation phase and histologic subtype in patients with locally advanced cervical cancer (LACC) treated with chemoradiation. We retrospectively reviewed the medical records of 398 patients with FIGO stage IIB-IVA cervical cancer treated with concurrent chemoradiotherapy (CCRT) between 2001 and 2019. Tumor response was assessed using serial magnetic resonance imaging (MRI) at three time points: pre-treatment, post-external beam radiotherapy (EBRT), and post-intracavitary radiotherapy (ICR). Tumor regression pattern according to histologic subtype and radiation phase (EBRT and ICR) was evaluated. Overall survival (OS) and progression-free survival (PFS) were the primary outcomes. Of 398 patients, 44 patients had adenocarcinoma/adenosquamous carcinoma (AC/ASC) and 354 patients had squamous cell carcinoma (SCC). AC/ASC was associated with significantly worse PFS and OS than SCC ( < 0.001). AC/ASC had a relatively poorer regression rate in response to EBRT than SCC ( < 0.001), whereas there was no significant difference in overall tumor regression rate after completion of RT (EBRT and ICR) between the two histologic subtypes. Multivariable analysis demonstrated AC/ASC histology to be an independent prognostic factor of decreased PFS and OS. Moreover, tumor regression rate after completion of EBRT (post-EBRT tumor regression rate (EBRT ≤ 26%) and proportion of tumor regression during EBRT to overall tumor regression (EBRT ≤ 40%) were independent predictors of poor survival in patients with LACC. Tumor regression pattern of LACC in response to CCRT differs according to histologic subtype. AC/ASC histology and poor tumor response to EBRT are independent prognostic factors for worse survival in patients with LACC. Further studies are needed to develop a CCRT protocol that is specialized for patients with AC/ASC.
本研究旨在评估同步放化疗治疗的局部晚期宫颈癌（LACC）患者中，根据放疗阶段和组织学亚型划分的肿瘤退缩率的预后意义。我们回顾性分析了2001年至2019年间接受同步放化疗（CCRT）的398例FIGO IIB-IVA期宫颈癌患者的病历。在三个时间点使用系列磁共振成像（MRI）评估肿瘤反应：治疗前、体外照射放疗（EBRT）后和腔内放疗（ICR）后。评估了根据组织学亚型和放疗阶段（EBRT和ICR）的肿瘤退缩模式。总生存期（OS）和无进展生存期（PFS）是主要结局。在398例患者中，44例为腺癌/腺鳞癌（AC/ASC），354例为鳞状细胞癌（SCC）。AC/ASC患者的PFS和OS显著差于SCC患者（<0.001）。与SCC相比，AC/ASC对EBRT的退缩率相对较差（<0.001），而两种组织学亚型在放疗（EBRT和ICR）完成后的总体肿瘤退缩率无显著差异。多变量分析表明，AC/ASC组织学是PFS和OS降低的独立预后因素。此外，EBRT完成后的肿瘤退缩率（EBRT后肿瘤退缩率（EBRT≤26%）以及EBRT期间肿瘤退缩占总体肿瘤退缩的比例（EBRT≤40%））是LACC患者生存不良的独立预测因素。LACC对CCRT的肿瘤退缩模式因组织学亚型而异。AC/ASC组织学和对EBRT的肿瘤反应差是LACC患者生存较差的独立预后因素。需要进一步研究来制定专门针对AC/ASC患者的CCRT方案。
