Chao Xiaopei, Song Xiaochen, Wu Huanwen, You Yan, Wu Ming, Li Lei
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China.
Department of Pathology, Peking Union Medical College Hospital, Beijing, China.
Front Oncol. 2021 Feb 2;11:618485. doi: 10.3389/fonc.2021.618485. eCollection 2021.
The selection of individualized treatment for recurrent cervical cancer is challenging. This study aimed to investigate the impact of various therapies on survival outcomes after recurrence.
Eligible patients were diagnosed with recurrent cervical cancer between March 2012 and April 2018. Postrecurrence progression-free survival (PFS) and overall survival (OS) were investigated in the whole cohort and in subgroups, categorized by recurrence site and prior radiotherapy history, using a multivariate model that incorporated treatment for primary and recurrent tumors, histological pathology, and FIGO staging.
Two hundred and sixty recurrent cervical cancer patients were included. As of March 1, 2020, the median postrecurrence PFS and OS were 7.0 (range 0-94) and 24.0 (1.8-149.1) months, respectively. In a multivariate model measured by PFS, radiotherapy was superior to other therapies for the whole cohort (=0.029) and recurrence only within the pelvic cavity (=0.005), but the advantages of radiotherapy disappeared in patients with a history of radiotherapy ( values >0.05). For recurrence only beyond the pelvic cavity, combination therapy resulted in improved PFS (=0.028). For recurrence both within and beyond the pelvic cavity, no therapy regimen provided additional PFS benefits ( values >0.05). Radiotherapy and combination therapy were also associated with improved postrecurrence OS for recurrence within the pelvic cavity (=0.034) and only beyond the pelvic cavity (=0.017), respectively.
In cervical cancer patients, postrecurrence radiotherapy can improve PFS and OS for patients with recurrence within the pelvic cavity and without prior radiotherapy. For recurrence beyond the pelvic cavity or cases with a history of radiotherapy, combination or individualized therapy may provide potential survival benefits.
为复发性宫颈癌选择个体化治疗具有挑战性。本研究旨在探讨各种疗法对复发后生存结局的影响。
符合条件的患者于2012年3月至2018年4月期间被诊断为复发性宫颈癌。在整个队列以及按复发部位和既往放疗史分类的亚组中，使用纳入了原发性和复发性肿瘤治疗、组织病理学和国际妇产科联盟（FIGO）分期的多变量模型，研究复发后无进展生存期（PFS）和总生存期（OS）。
纳入了260例复发性宫颈癌患者。截至2020年3月1日，复发后的中位PFS和OS分别为7.0（范围0 - 94）个月和24.0（1.8 - 149.1）个月。在以PFS衡量的多变量模型中，对于整个队列（P = 0.029）和仅盆腔内复发（P = 0.005），放疗优于其他疗法，但放疗的优势在有放疗史的患者中消失（P值>0.05）。对于仅盆腔外复发，联合治疗可改善PFS（P = 0.028）。对于盆腔内和盆腔外均有复发的情况，没有治疗方案能提供额外的PFS益处（P值>0.05）。放疗和联合治疗也分别与盆腔内复发（P = 0.034）和仅盆腔外复发（P = 0.017）后的复发后OS改善相关。
在宫颈癌患者中，复发后放疗可改善盆腔内复发且无既往放疗史患者的PFS和OS。对于盆腔外复发或有放疗史的病例，联合或个体化治疗可能提供潜在的生存益处。
