Yuan Zhen, Cao Dongyan, Zhang Ying, Shen Keng, Yang Jiaxin, Yu Mei, Zhou Huimei
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Risk Manag Healthc Policy. 2021 Jan 11;14:109-116. doi: 10.2147/RMHP.S273848. eCollection 2021.
The aim of this study was to explore whether adjuvant chemotherapy could improve prognosis for cervical cancer patients with elevated pretreatment serum squamous-cell carcinoma antigen (SCC-Ag).
Propensity-score matching and inverse probability of treatment weighting (IPTW) were used to ensure balanced groups for patients with (arm A) and without adjuvant chemotherapy (arm B). All patients were treated between January 2012 and December 2014 at a single center. Study outcomes were disease-free survival (DFS) and overall survival (OS).
In total, 81 patients were included in this study. By propensity-score matching, 35 patients were included in each group (arm A and arm B). Median follow-up was 60 months in arm A and 66 months in arm B. Overall, 85.7% of patients in arm A and 71.4% of those in arm B received adjuvant radiotherapy. DFS and OS curves were similar between arms A and B (=0.971 and 0.633, respectively). With IPTW, arm A was not associated with prognosis in terms of DFS (HR 0.946, 95% CI 0.237-3.784; =0.938) or OS (HR 1.020, 95%CI 0.357-2.913; =0.970).
For patients with elevated pretreatment SCC-Ag, adjuvant chemotherapy was not found to improve prognosis. Also, a considerable proportion of these patients had postoperative indications for adjuvant radiotherapy. For these cervical cancer patients with elevated pretreatment SCC-Ag, the choice of radical hysterectomy and adjuvant chemotherapy should be prudent.
本研究旨在探讨辅助化疗能否改善治疗前血清鳞状细胞癌抗原（SCC-Ag）升高的宫颈癌患者的预后。
采用倾向评分匹配和治疗权重逆概率法（IPTW），确保接受（A组）和未接受辅助化疗（B组）的患者组间均衡。所有患者于2012年1月至2014年12月在单一中心接受治疗。研究结局为无病生存期（DFS）和总生存期（OS）。
本研究共纳入81例患者。通过倾向评分匹配，每组纳入35例患者（A组和B组）。A组的中位随访时间为60个月，B组为66个月。总体而言，A组85.7%的患者和B组71.4%的患者接受了辅助放疗。A组和B组的DFS和OS曲线相似（分别为=0.971和0.633）。采用IPTW时，A组在DFS（HR 0.946，95%CI 0.237-3.784；=0.938）或OS（HR 1.020，95%CI 0.357-2.913；=0.970）方面与预后无关。
对于治疗前SCC-Ag升高的患者，未发现辅助化疗能改善预后。此外，这些患者中有相当一部分有术后辅助放疗的指征。对于这些治疗前SCC-Ag升高的宫颈癌患者，根治性子宫切除术和辅助化疗的选择应谨慎。
