老年宫颈癌患者的生存率无改善——一项全国性研究。

No improvement in survival of older women with cervical cancer-A nationwide study.

机构信息

Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.

Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands.

出版信息

Eur J Cancer. 2021 Jul;151:159-167. doi: 10.1016/j.ejca.2021.04.014. Epub 2021 May 13.

DOI:10.1016/j.ejca.2021.04.014

PMID:33993062

Abstract

AIM

This study aims to report trends in primary treatment and survival in cervical cancer (CC) to identify opportunities to improve clinical practice and disease outcome.

METHODS

Patients diagnosed with CC between 1989 and 2018 were identified from the Netherlands Cancer Registry (N = 21,644). Trends in primary treatment and 5-year relative survival were analysed with the Cochran-Armitage trend test and multivariable Poisson regression, respectively.

RESULTS

In early CC, surgery remains the preferred treatment for ages 15-74. Overall, it was applied more often in younger than in older patients (92% in 15-44; 64% in 65-74). For 75+, surgery use was stable over time (38%-41%, p=0.368), while administration of radiotherapy decreased (57%-29%, p < 0.001). In locally advanced CC, chemoradiation use increased over time (5%-65%, p < 0.001). It was applied least often for 75+, in which radiotherapy remains most common (54% in 2014-2018). In metastatic CC, chemotherapy use increased over time (11%-28%, p < 0.001), but varied across age groups (6%-40% in 2014-2018). In patients treated with primary chemoradiation, regardless of stage, brachytherapy use increased over time (p ≤ 0.001). Full cohort 5-year survival increased from 68% to 74% (relative excess risk 0.55; 95% confidence interval [0.50-0.62]). Increases were most significant in locally advanced CC (38%-60%; 0.55 [0.47-0.65]). Survival remained stable in 75+ (38%-34%; 0.82 [0.66-1.02]).

CONCLUSION

Relative survival for cervical cancer increased over the last three decades. The proportion of older patients receiving preferred treatment lags behind. Consequently, survival did not improve in the oldest patients.

摘要

目的

本研究旨在报告宫颈癌（CC）的主要治疗方法和生存趋势，以确定改善临床实践和疾病结局的机会。

方法

从荷兰癌症登记处（N=21644）中确定了 1989 年至 2018 年间诊断为 CC 的患者。采用 Cochran-Armitage 趋势检验和多变量泊松回归分别分析主要治疗方法和 5 年相对生存率的趋势。

结果

在早期 CC 中，手术仍然是 15-74 岁患者的首选治疗方法。总体而言，在年轻患者中比在老年患者中更常应用（15-44 岁时为 92%；65-74 岁时为 64%）。对于 75 岁以上的患者，手术的使用率随时间保持稳定（38%-41%，p=0.368），而放疗的使用率下降（57%-29%，p<0.001）。在局部晚期 CC 中，化疗联合放疗的使用率随时间增加（5%-65%，p<0.001）。对于 75 岁以上的患者，其使用率最低，放疗仍是最常见的治疗方法（2014-2018 年为 54%）。在转移性 CC 中，化疗的使用率随时间增加（11%-28%，p<0.001），但在不同年龄组之间存在差异（2014-2018 年为 6%-40%）。在接受原发放化疗的患者中，无论分期如何，近距离放疗的使用率随时间增加（p≤0.001）。全队列 5 年生存率从 68%增加到 74%（相对超额风险 0.55；95%置信区间[0.50-0.62]）。在局部晚期 CC 中，增加最为显著（38%-60%；0.55[0.47-0.65]）。75 岁以上患者的生存率保持稳定（38%-34%；0.82[0.66-1.02]）。