Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Int J Gynecol Cancer. 2021 Jan;31(1):52-58. doi: 10.1136/ijgc-2020-001974. Epub 2020 Dec 10.
Adjuvant treatment remains a controversial issue for intermediate-risk cervical cancer. The aim of this study was to compare the prognosis of patients who underwent no adjuvant treatment, pelvic radiotherapy alone, or concurrent chemoradiotherapy after radical hysterectomy for intermediate-risk, early-stage cervical cancer.
Patients with stage IB1-IIA2 (FIGO 2009) cervical squamous cell carcinoma treated with radical hysterectomy and pelvic lymph node dissection, with negative lymph nodes, surgical margins, or parametria, who had combined intermediate risk factors as defined in the Gynecologic Oncology Group trial (GOG-92; Sedlis criteria) were included in the study. Recurrence-free survival and disease-specific survival were compared.
Of 861 patients included in the analysis, 85 patients received no adjuvant treatment, 283 patients were treated with radiotherapy, and 493 patients with concurrent chemoradiotherapy. After a median follow-up of 63 months (IQR 45 to 84), adjuvant radiotherapy or concurrent chemoradiotherapy was not associated with a survival benefit compared with no adjuvant treatment. The 5-year recurrence-free survival and corresponding disease-specific survival were 87.1%, 84.2%, 89.6% (p=0.27) and 92.3%, 87.7%, 91.4% (p=0.20) in the no adjuvant treatment, radiotherapy alone, and concurrent chemoradiotherapy groups, respectively. Lymphovascular space invasion was the only independent prognostic factor for both recurrence-free survival and disease-specific survival. Additionally, significant heterogeneity exists in Sedlis criteria: higher risk of relapse (HR=1.88; 95% CI 1.19 to 2.97; p=0.007) and death (HR=2.36; 95% CI 1.41 to 3.95; p=0.001) occurred in patients with lymphovascular space invasion and deep 1/3 stromal invasion compared with no lymphovascular space invasion, middle or deep 1/3 stromal invasion, and tumor diameter ≥4 cm.
Radical hysterectomy alone without adjuvant treatment may achieve a favorable survival for patients with intermediate-risk cervical cancer as defined by Sedlis criteria. Criteria for adjuvant treatment in patients without high risk factors need to be further evaluated.
辅助治疗对于中危宫颈癌仍然存在争议。本研究旨在比较接受根治性子宫切除术的中危早期宫颈癌患者不接受辅助治疗、单纯盆腔放疗或同期放化疗的预后。
纳入接受根治性子宫切除术和盆腔淋巴结清扫术且淋巴结阴性、切缘阴性或宫旁阴性的FIGO 2009 期 IB1-IIA2(GOG-92 中定义的妇科肿瘤学组试验)宫颈鳞癌患者,且具有联合中危因素的患者。比较无复发生存率和疾病特异性生存率。
在 861 名纳入分析的患者中,85 名患者未接受辅助治疗,283 名患者接受放疗,493 名患者接受同期放化疗。中位随访 63 个月(IQR 45 至 84)后,与未接受辅助治疗相比,辅助放疗或同期放化疗并未带来生存获益。无辅助治疗、单纯放疗和同期放化疗组的 5 年无复发生存率和相应的疾病特异性生存率分别为 87.1%、84.2%、89.6%(p=0.27)和 92.3%、87.7%、91.4%(p=0.20)。淋巴管血管间隙侵犯是无复发生存率和疾病特异性生存率的唯一独立预后因素。此外,Sedlis 标准存在显著异质性:与无淋巴管血管间隙侵犯、中或深 1/3 间质侵犯和肿瘤直径≥4cm 相比,淋巴管血管间隙侵犯和深 1/3 间质侵犯的患者复发风险(HR=1.88;95%CI 1.19 至 2.97;p=0.007)和死亡风险(HR=2.36;95%CI 1.41 至 3.95;p=0.001)更高。
根据 Sedlis 标准,对于中危宫颈癌患者,单纯根治性子宫切除术而不接受辅助治疗可能获得良好的生存。需要进一步评估无高危因素患者的辅助治疗标准。