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多机构回顾性分析同步放化疗后接受铂类辅助化疗的局部晚期宫颈癌患者的肿瘤学结局。

A Multi-Institutional Retrospective Analysis of Oncologic Outcomes for Patients With Locally Advanced Cervical Cancer Undergoing Platinum-Based Adjuvant Chemotherapy After Concurrent Chemoradiotherapy.

机构信息

Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China.

Department of Radiation Oncology, Beijing Cancer Hospital, Beijing, China.

出版信息

Cancer Control. 2021 Jan-Dec;28:1073274821989307. doi: 10.1177/1073274821989307.


DOI:10.1177/1073274821989307
PMID:33593091
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8482744/
Abstract

OBJECTIVE: To evaluated the oncologic outcomes associated with platinum-based adjuvant chemotherapy following concurrent chemoradiotherapy (CCRT) in the management of patients with locally advanced cervical cancer (LACC). METHODS: A total of 695 patients with FIGO stage IB2, IIA2, IIB-IVA LACC treated at 6 medical facilities were enrolled and divided into 2 groups: 478 were assigned to CCRT alone (CCRT group) and 217 to adjuvant chemotherapy after CCRT (CCRT-ACT group). The treatment outcomes were retrospectively compared and reported after the propensity score matching (PSM) analysis. RESULTS: With a median follow-up of 56.4 months, no statistically significant differences were found in overall survival (OS), disease-free survival (DFS), progression-free survival (PFS) and distance metastasis-free survival (DMFS) between 2 groups. In CCRT-ACT group, patients with lymph nodes involvement or squamous cell carcinoma (SCC) had significantly longer DMFS, but no significant benefit in survival outcomes were observed with more than 2 cycles of adjuvant chemotherapy. Moreover, patients with a high level of CA125 (>20.5U/mL) or SCC-Ag (>22.8μg/L) had a relatively better DFS or PFS, and grade 3-4 acute hematological toxicity, late urinary and lower gastrointestinal complications and diarrhea symptom were more frequent in CCRT-ACT group. CONCLUSIONS: Adjuvant chemotherapy after CCRT has a potential role in further improving disease control for LACC patients with lymph nodal-metastasis or SCC with a high level of CA125 or SCC-Ag. Due to increased treatment-related complications and diarrhea symptom affecting the quality of life, post-CCRT adjuvant chemotherapy with excessive cycles was not be considered as the most appropriate choice in general.

摘要

目的:评估同步放化疗(CCRT)后接受铂类辅助化疗治疗局部晚期宫颈癌(LACC)患者的肿瘤学结局。

方法:共纳入 695 例接受治疗的 FIGO 分期 IB2、IIA2、IIB-IVA LACC 患者,分为两组:478 例患者仅接受 CCRT(CCRT 组),217 例患者在 CCRT 后接受辅助化疗(CCRT-ACT 组)。通过倾向评分匹配(PSM)分析,回顾性比较两组患者的治疗结果。

结果:中位随访 56.4 个月后,两组患者的总生存(OS)、无病生存(DFS)、无进展生存(PFS)和远处转移无复发生存(DMFS)无统计学差异。在 CCRT-ACT 组中,有淋巴结转移或鳞状细胞癌(SCC)的患者 DMFS 明显延长,但辅助化疗超过 2 个周期时,生存结果未见显著获益。此外,CA125 水平较高(>20.5U/mL)或 SCC-Ag 水平较高(>22.8μg/L)的患者DFS 或 PFS 相对较好,且 CCRT-ACT 组中 3-4 级急性血液学毒性、晚期尿和下消化道并发症以及腹泻症状更为常见。

结论:CCRT 后辅助化疗对淋巴结转移或 SCC、CA125 或 SCC-Ag 水平较高的 LACC 患者有进一步改善疾病控制的作用。但由于治疗相关并发症增加和腹泻症状影响生活质量,一般不考虑辅助化疗过多周期作为最佳选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1bbf/8482744/1091cbb5e7b3/10.1177_1073274821989307-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1bbf/8482744/f3bcd94400a9/10.1177_1073274821989307-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1bbf/8482744/a3eda182557c/10.1177_1073274821989307-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1bbf/8482744/f759293603cb/10.1177_1073274821989307-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1bbf/8482744/1091cbb5e7b3/10.1177_1073274821989307-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1bbf/8482744/f3bcd94400a9/10.1177_1073274821989307-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1bbf/8482744/a3eda182557c/10.1177_1073274821989307-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1bbf/8482744/f759293603cb/10.1177_1073274821989307-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1bbf/8482744/1091cbb5e7b3/10.1177_1073274821989307-fig4.jpg

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J Natl Cancer Cent. 2025-1-9

[2]
Radiomics feature is a risk factor for locally advanced cervical cancer treated using concurrent chemoradiotherapy based on magnetic resonance imaging: a retrospective study.

BMC Cancer. 2025-2-10

[3]
Clinical practice guidelines for cervical cancer: the Korean Society of Gynecologic Oncology guidelines.

J Gynecol Oncol. 2024-3

[4]
Relationships among Inflammatory Biomarkers and Objectively Assessed Physical Activity and Sleep during and after Chemotherapy for Gynecologic Malignancies.

Cancers (Basel). 2023-7-30

[5]
Dynamic Nomogram Based on the Metastatic Number and Sites and Therapy Strategies Predicting the Prognosis of Patients with Metastatic Cervical Cancer.

Int J Womens Health. 2022-12-22

[6]
Treatment Strategies and Prognostic Factors of 2018 FIGO Stage IIIC Cervical Cancer: A Review.

Technol Cancer Res Treat. 2022

本文引用的文献

[1]
Does adenocarcinoma have a worse prognosis than squamous cell carcinoma in patients with cervical cancer? A real-world study with a propensity score matching analysis.

J Gynecol Oncol. 2020-11

[2]
Adjuvant chemotherapy after radiotherapy or concurrent chemoradiotherapy for pelvic lymph node-positive patients with locally advanced cervical cancer: a propensity score matching analysis.

Int J Gynecol Cancer. 2022-1

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A randomized controlled trial comparing concurrent chemoradiation versus concurrent chemoradiation followed by adjuvant chemotherapy in locally advanced cervical cancer patients: ACTLACC trial.

J Gynecol Oncol. 2019-4-10

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Disparities in Cancer Incidence among Chinese Population versus Migrants to Developed Regions: A Population-Based Comparative Study.

Cancer Epidemiol Biomarkers Prev. 2019-4-3

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J Obstet Gynaecol. 2019-4

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