Scharl Sophia, Becher Cornelia, Gerken Michael, Scharl Anton, Anapolski Michael, Ignatov Atanas, Inwald Elisabeth C, Ortmann Olaf, Kölbl Oliver, Klinkhammer-Schalke Monika, Papathemelis Thomas
Department of Radiation Oncology and Nuclear Medicine, Medizinisches Versorgungszentrum am Klinikum Rosenheim, Rosenheim, Germany.
Tumor Center, Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany.
Arch Gynecol Obstet. 2021 Sep;304(3):759-771. doi: 10.1007/s00404-021-05989-w. Epub 2021 Feb 11.
Due to insufficient and conflicting prospective evidence, the recommendations on when to apply adjuvant radiochemotherapy in early-stage cervical cancer vary between international guidelines. In this population-based study, we evaluated the outcome of patients with early-stage cervical cancer based on risk factors and the adjuvant therapy they received.
The effect of primary therapy (surgery and radiochemotherapy RCT, surgery and radiotherapy RT, and surgery alone) on overall survival (OS) and recurrence-free survival (RFS) was evaluated in the complete cohort of 442 patients and in subgroups according to risk profile and nodal status.
In low-risk patients, there was no difference in OS (p = 0.276) depending on whether patients received adjuvant therapy or not. Concerning RFS, patients with RT (including one patient with RCT) exhibited a significantly worse outcome compared to the group with surgery alone (p = 0.015). In intermediate-risk patients, the administration of adjuvant RT significantly benefited RFS when compared to surgery only in multivariate analysis (p = 0.031). Concerning OS, no significant influence for adjuvant treatment could be seen (p = 0.354). Though trends towards better OS and RFS could be observed in patients of the high-risk group-both in RCT and RT groups compared to surgery alone-the effects did not prove to be significant.
Our study reaffirms the evidence against the use of adjuvant radio(chemo)therapy in low-risk early-stage cervical cancer. In intermediate-, and less pronounced in high-risk patients, however, it seems to be beneficial. The role of adjuvant radio(chemo)therapy in early cervical cancer should be further investigated in prospective randomized trials.
由于前瞻性证据不足且相互矛盾，国际指南对于早期宫颈癌何时应用辅助放化疗的建议各不相同。在这项基于人群的研究中，我们根据危险因素及患者接受的辅助治疗评估了早期宫颈癌患者的预后。
在442例患者的完整队列中以及根据风险特征和淋巴结状态划分的亚组中，评估了初始治疗（手术与放化疗随机对照试验、手术与放疗、单纯手术）对总生存期（OS）和无复发生存期（RFS）的影响。
在低风险患者中，无论是否接受辅助治疗，OS均无差异（p = 0.276）。关于RFS，接受放疗（包括1例接受放化疗随机对照试验的患者）的患者与单纯手术组相比，预后明显更差（p = 0.015）。在中风险患者中，多因素分析显示，与单纯手术相比，辅助放疗对RFS有显著益处（p = 0.031）。关于OS，未观察到辅助治疗有显著影响（p = 0.354）。尽管在高风险组患者中，与单纯手术相比，放化疗随机对照试验组和放疗组的OS和RFS均有改善趋势，但效果并不显著。
我们的研究再次证实，不支持在低风险早期宫颈癌中使用辅助放（化）疗。然而，在中风险患者中似乎有益，在高风险患者中益处较小。辅助放（化）疗在早期宫颈癌中的作用应在前瞻性随机试验中进一步研究。
