人免疫缺陷病毒阳性或阴性的 IIIB 期宫颈癌患者采用放化疗与单纯放疗的比较。
Chemoradiation versus radiation alone in stage IIIB cervical cancer patients with or without human immunodeficiency virus.
机构信息
Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Oncology, University of Botswana, Gaborone, Botswana.
出版信息
Int J Gynecol Cancer. 2021 Sep;31(9):1220-1227. doi: 10.1136/ijgc-2021-002601. Epub 2021 Jul 26.
OBJECTIVE
Cervical cancer remains the most common cancer among women in sub-Saharan Africa and is also a leading cause of cancer related deaths among these women. The benefit of chemoradiation in comparison with radiation alone for patients with stage IIIB disease has not been evaluated prospectively in women living with human immunodeficiency virus (HIV). We assessed the survival of chemoradiation versus radiation alone among stage IIIB cervical cancer patients based on HIV status.
METHODS
Between February 2013 and June 2018, patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIIB cervical cancer with or without HIV and treated with chemoradiation or radiation alone, were prospectively enrolled in an observational cohort study. Overall survival was evaluated using the Kaplan-Meier method. Cox proportional hazards modeling was used to analyze associations with survival.
RESULTS
Among 187 patients, 63% (n=118) of women had co-infection with HIV, and 48% (n=69) received chemoradiation. Regardless of HIV status, patients who received chemoradiation had improved 2 year overall survival compared with those receiving radiation alone (59% vs 41%, p<0.01), even among women living with HIV (60% vs 38%, p=0.02). On multivariable Cox regression analysis, including all patients regardless of HIV status, 2 year overall survival was associated with receipt of chemoradiation (hazard ratio (HR) 0.63, p=0.04) and total radiation dose ≥80 Gy (HR 0.57, p=0.02). Among patients who received an adequate radiation dose of ≥80 Gy, adjusted overall survival rates were similar between chemoradiation versus radiation alone groups (HR 1.07; p=0.90). However, patients who received an inadequate radiation dose of <80 Gy, adjusted survival was significantly higher in chemoradiation versus radiation alone group (HR 0.45, p=0.01).
CONCLUSIONS
Addition of chemotherapy to standard radiation improved overall survival, regardless of HIV status, and is even more essential in women who cannot receive full doses of radiation.
目的
在撒哈拉以南非洲，宫颈癌仍然是女性中最常见的癌症，也是这些女性癌症相关死亡的主要原因。对于患有 IIIB 期疾病的患者，与单独放疗相比，化疗联合放疗的益处尚未在人类免疫缺陷病毒（HIV）感染者中进行前瞻性评估。我们根据 HIV 状况评估了 IIIB 期宫颈癌患者接受化疗联合放疗与单独放疗的生存情况。
方法
2013 年 2 月至 2018 年 6 月，前瞻性纳入国际妇产科联合会（FIGO）2009 年 IIIB 期宫颈癌伴或不伴 HIV 的患者，接受化疗联合放疗或单独放疗。采用 Kaplan-Meier 法评估总生存率。采用 Cox 比例风险模型分析与生存相关的因素。
结果
在 187 例患者中，63%（n=118）的女性合并 HIV 感染，48%（n=69）接受化疗联合放疗。无论 HIV 状态如何，接受化疗联合放疗的患者 2 年总生存率均优于单独接受放疗的患者（59%比 41%，p<0.01），即使在 HIV 感染者中也是如此（60%比 38%，p=0.02）。多变量 Cox 回归分析包括所有患者，无论 HIV 状态如何，2 年总生存率与接受化疗联合放疗（风险比（HR）0.63，p=0.04）和总放疗剂量≥80 Gy（HR 0.57，p=0.02）相关。在接受≥80 Gy 充分放疗剂量的患者中，化疗联合放疗与单独放疗组的调整后总生存率相似（HR 1.07；p=0.90）。然而，在接受<80 Gy 放疗剂量不足的患者中，化疗联合放疗组的调整后生存率明显高于单独放疗组（HR 0.45，p=0.01）。
结论
与单独放疗相比，标准放疗联合化疗可提高总体生存率，无论 HIV 状况如何，对于不能接受全剂量放疗的女性更为重要。
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