The Second Affiliated Hospital of Fujian Medical University, Department of Radiotherapy, Quanzhou, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
Jpn J Clin Oncol. 2021 Apr 1;51(4):630-638. doi: 10.1093/jjco/hyaa251.
We used National Cancer Institute's Surveillance, Epidemiology and End Result database to assess the role of salvage radiotherapy for women with unanticipated cervical cancer after simple hysterectomy.
Patients with non-metastatic cervical cancer and meeting inclusion criteria were divided into three groups based on treatment strategy: simple hysterectomy, salvage radiotherapy after hysterectomy and radical surgery. Parallel propensity score-matched datasets were established for salvage radiotherapy group vs. simple hysterectomy group (matching ratio 1: 1), and salvage radiotherapy group vs. radical surgery group (matching ratio 1:2). The primary endpoint was the overall survival advantage of salvage radiotherapy over simple hysterectomy or radical surgery within the propensity score-matched datasets.
In total, 2682 patients were recruited: 647 in the simple hysterectomy group, 564 in the salvage radiotherapy group and 1471 in the radical surgery group. Age, race, histology, grade, FIGO stage, insured and marital status and chemotherapy were comprised in propensity score-matched. Matching resulted in two comparison groups with neglectable differences in most variables, except for black race, FIGO stage III and chemotherapy in first matching. In the matched analysis for salvage radiotherapy vs. simple hysterectomy, the median follow-up time was 39 versus 32 months. In the matched analysis for salvage radiotherapy vs. radical surgery, the median follow-up time was 39 and 41 months, respectively. Salvage radiotherapy (HR 0.53, P = 0.046) significantly improved overall survival compared with simple hysterectomy, while salvage radiotherapy cannot achieve similar overall survival to radical surgery (HR 1.317, P = 0.045).
This is the largest study of the effect of salvage radiotherapy on overall survival in patients with unanticipated cervical cancer. Salvage radiotherapy can improve overall survival compared with hysterectomy alone, while cannot achieve comparable survival to radical surgery.
我们利用美国国立癌症研究所的监测、流行病学和最终结果数据库评估对单纯子宫切除术后出现意外宫颈癌的女性进行挽救性放疗的作用。
符合纳入标准的非转移性宫颈癌患者根据治疗策略分为三组：单纯子宫切除术、子宫切除术后挽救性放疗和根治性手术。为挽救性放疗组与单纯子宫切除术组（匹配比例 1:1）和挽救性放疗组与根治性手术组（匹配比例 1:2）分别建立平行倾向评分匹配数据集。主要终点是在倾向评分匹配数据集中，挽救性放疗与单纯子宫切除术或根治性手术相比的总体生存优势。
共纳入 2682 例患者：单纯子宫切除术组 647 例，挽救性放疗组 564 例，根治性手术组 1471 例。年龄、种族、组织学、分级、FIGO 分期、保险和婚姻状况以及化疗均包含在倾向评分匹配中。匹配后，除了在第一次匹配中黑色人种、FIGO 分期 III 期和化疗外，两组在大多数变量上差异可以忽略不计。在挽救性放疗与单纯子宫切除术的匹配分析中，中位随访时间为 39 个月与 32 个月。在挽救性放疗与根治性手术的匹配分析中，中位随访时间分别为 39 个月和 41 个月。挽救性放疗（HR 0.53，P=0.046）与单纯子宫切除术相比显著改善了总体生存，而挽救性放疗不能达到与根治性手术相当的总体生存（HR 1.317，P=0.045）。
这是评估挽救性放疗对意外宫颈癌患者总体生存影响的最大研究。挽救性放疗可改善与单纯子宫切除术相比的总体生存，而不能达到与根治性手术相当的生存。
