Park Soo Jin, Mun Jaehee, Lee Seungmee, Luo Yanlin, Chung Hyun Hoon, Kim Jae-Weon, Park Noh Hyun, Song Yong Sang, Kim Hee Seung
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.
Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea.
Front Oncol. 2021 May 25;11:683441. doi: 10.3389/fonc.2021.683441. eCollection 2021.
Laterally extended endopelvic resection (LEER) has been introduced for treatment of pelvic sidewall recurrence of cervical cancer (PSRCC), which occurs in only 8% of patients with relapsed cervical cancer. LEER can only be performed by a proficient surgeon due to the high risk of surgical morbidity and mortality, but there is no evidence as to whether LEER is may be more effective than chemo or targeted therapy alone for PSRCC. Thus, we aimed to compare the efficacy and safety between LEER and chemo or targeted therapy alone for treatment of PSRCC.
We prospectively recruited patients with PSRCC who underwent LEER between December 2016 and December 2019. Moreover, we retrospectively collected data on patients with PSRCC who received chemo or targeted therapy alone between January 2000 and December 2019. We compared treatment-free interval (TFI), progression-free survival (PFS), treatment-free survival (TFS), overall survival (OS), tumor response, neurologic disturbance of the low extremities, and pelvic pain severity in the different patient groups.
Among 1295 patients with cervical cancer, we included 28 (2.2%) and 31 (2.4%) in the prospective and retrospective cohorts, respectively. When we subdivided all patients into two groups based on the median value of prior TFI (PTFI, 9.2 months), LEER improved TFI, PFS, TRS and OS compared to chemo or targeted therapy alone (median, 2.8 0.9; 7.4 4.1; 30.1 16.9 months; P ≤ 0.05) in patients with PTFI < 9.2 months despite no difference in survival in those with PTFI ≥ 9.2 months, suggesting that LEER may lead to better TFI, PFS, TRS and OS in patients with PTFI < 9.2 months (adjusted hazard ratios, 0.28, 0.27, 0.44 and 0.37; 95% confidence intervals, 0.12-0.68, 0.11-0.66, 0.18-0.83 and 0.15-0.88). Furthermore, LEER markedly reduced the number of morphine milligram equivalents necessary to reduce pelvic pain when compared with chemo or targeted therapy alone.
Compared to chemo or targeted therapy alone, LEER improved survival in patients with PSRCC and PTFI < 9.2 months, and it was effective at controlling the pelvic pain associated with PSRCC.
ClinicalTrials.gov, identifier NCT02986568.
盆腔侧壁扩展根治性切除术（LEER）已被用于治疗宫颈癌盆腔侧壁复发（PSRCC），这种情况仅发生在8%的复发性宫颈癌患者中。由于手术发病率和死亡率高，LEER只能由熟练的外科医生进行，但尚无证据表明LEER对PSRCC的疗效是否优于单纯化疗或靶向治疗。因此，我们旨在比较LEER与单纯化疗或靶向治疗在PSRCC治疗中的疗效和安全性。
我们前瞻性招募了2016年12月至2019年12月期间接受LEER的PSRCC患者。此外，我们回顾性收集了2000年1月至2019年12月期间接受单纯化疗或靶向治疗的PSRCC患者的数据。我们比较了不同患者组的无治疗间隔（TFI）、无进展生存期（PFS）、无治疗生存期（TFS）、总生存期（OS）、肿瘤反应、下肢神经功能障碍和盆腔疼痛严重程度。
在1295例宫颈癌患者中，我们分别在前瞻性队列和回顾性队列中纳入了28例（2.2%）和31例（2.4%）。当我们根据先前TFI（PTFI，9.2个月）的中位数将所有患者分为两组时，与单纯化疗或靶向治疗相比，LEER改善了PTFI < 9.2个月患者的TFI、PFS、TRS和OS（中位数，2.8 0.9；7.4 4.1；30.1 16.9个月；P≤0.05），尽管PTFI≥9.2个月的患者生存率无差异，这表明LEER可能使PTFI < 9.2个月的患者获得更好的TFI、PFS、TRS和OS（调整后的风险比，0.28、0.27、0.44和0.37；95%置信区间，0.12 - 0.68、0.11 - 0.66、0.18 - 0.83和0.15 - 0.88）。此外，与单纯化疗或靶向治疗相比，LEER显著减少了减轻盆腔疼痛所需的吗啡毫克当量数。
与单纯化疗或靶向治疗相比，LEER改善了PTFI < 9.2个月的PSRCC患者的生存率，并且在控制与PSRCC相关的盆腔疼痛方面有效。
ClinicalTrials.gov，标识符NCT02986568。
