Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
Section of Urology, University of Chicago Medicine, Chicago, Illinois, USA.
Int J Gynecol Cancer. 2021 Jul;31(7):991-1000. doi: 10.1136/ijgc-2021-002655. Epub 2021 May 20.
To examine trends and outcomes related to adjuvant systemic chemotherapy alone for high risk, early stage cervical cancer.
This retrospective observational study queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program from 2000 to 2016. Surgically treated women with American Joint Commission on Cancer stages T1-2 cervical cancer who had high risk factors (nodal metastasis and/or parametrial invasion) and received additional therapy were examined. Propensity score inverse probability of treatment weighting was used to assess the survival estimates for systemic chemotherapy versus external beam radiotherapy with chemotherapy.
Among 2462 patients with high risk factors, 185 (7.5%) received systemic chemotherapy without external beam radiotherapy, of which the utilization significantly increased over time in multivariable analysis (adjusted odds ratio per 1 year increment 1.06, 95% confidence interval (CI) 1.02 to 1.09). In weighted models, adjuvant chemotherapy and combination therapy (external beam radiotherapy and chemotherapy) had comparable overall survival among patients aged <40 years (hazard ratio (HR) 0.73, 95% CI 0.41 to 1.33), in adenocarcinoma or adenosquamous histologies (HR 0.90, 95% CI 0.62 to 1.32), and in those with nodal metastasis alone without parametrial tumor invasion (HR 1.17, 95% CI 0.84 to 1.62). In contrast, systemic chemotherapy alone was associated with increased all cause mortality compared with combination therapy in patients aged ≥40 years (HR 1.57, 95% CI 1.19 to 2.06), with squamous histology (HR 1.63, 95% CI 1.19 to 2.22), and with parametrial invasion alone (HR 1.87, 95% CI 1.09 to 3.20) or parametrial invasion with nodal metastasis (HR 1.64, 95% CI 1.06 to 2.52).
Utilization of adjuvant systemic chemotherapy alone for high risk, early stage cervical cancer is increasing in the United States in the recent years. Our study suggests that survival effects of adjuvant systemic chemotherapy may vary based on patient and tumor factors. External beam radiotherapy with chemotherapy remains the standard for high risk, early stage cervical cancer, and use of adjuvant systemic chemotherapy without external beam radiotherapy should be considered with caution.
探讨高危早期宫颈癌单纯辅助全身化疗的趋势和结果。
本回顾性观察性研究利用美国国家癌症研究所的监测、流行病学和最终结果计划（2000 年至 2016 年）的数据进行分析。研究对象为接受手术治疗、美国癌症联合委员会（AJCC）分期为 T1-2 期宫颈癌且具有高危因素（淋巴结转移和/或宫旁侵犯）并接受辅助治疗的患者。采用倾向评分逆概率治疗加权法评估全身化疗与放化疗联合的生存估计值。
在 2462 例高危患者中，185 例（7.5%）未接受外照射放疗，而在多变量分析中，全身化疗的使用率随着时间的推移显著增加（每增加 1 年，调整后的优势比为 1.06，95%置信区间[CI]为 1.02 至 1.09）。在加权模型中，对于年龄<40 岁的患者（风险比[HR]0.73，95%CI 0.41 至 1.33）、腺癌或腺鳞癌患者（HR 0.90，95%CI 0.62 至 1.32）以及仅有淋巴结转移而无宫旁肿瘤侵犯的患者（HR 1.17，95%CI 0.84 至 1.62），辅助化疗和联合治疗（外照射放疗和化疗）的总生存率相当。相比之下，对于年龄≥40 岁的患者（HR 1.57，95%CI 1.19 至 2.06）、鳞癌患者（HR 1.63，95%CI 1.19 至 2.22）、单纯宫旁侵犯患者（HR 1.87，95%CI 1.09 至 3.20）或宫旁侵犯合并淋巴结转移患者（HR 1.64，95%CI 1.06 至 2.52），全身化疗单独应用与联合治疗相比，与全因死亡率增加相关。
近年来，美国高危早期宫颈癌单纯辅助全身化疗的使用率呈上升趋势。本研究表明，辅助全身化疗的生存效果可能因患者和肿瘤因素而异。放化疗联合仍是高危早期宫颈癌的标准治疗方法，应谨慎考虑不联合外照射放疗的单纯全身化疗。
