University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands.
University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands.
Radiother Oncol. 2021 Oct;163:150-158. doi: 10.1016/j.radonc.2021.08.020. Epub 2021 Sep 2.
To assess risk factors for nodal failure (NF) after definitive (chemo)radiotherapy and image-guided brachytherapy for locally advanced cervical cancer (LACC) for patients treated in the EMBRACE I study.
Data for pelvic NF and para-aortic (PAO) NF (NF) were analysed. After multiple imputation, univariable and multivariable Cox-regression was performed for clinical and treatment-related variables. For patients with affected pelvic nodes but no PAO nodes at diagnosis, additional analyses were performed for two subgroups: 1. 'small pelvis' nodes in internal and external iliac, obturator, parametrial, presacral and/or common iliac (CI) region and 2. any CI nodes (subgroup of 1).
1338 patients with 152 NF and 104 NF events were analysed with a median follow-up of 34.2 months (IQR 16.4-52.7). For the entire group, larger tumour width, nodal risk groups (in particular any CI nodes without PAO nodes), local failure, and lower Hb-nadir increased the risk of NF. Elective PAO-irradiation was independently associated with a decreased risk of NF (HR 0.53, 95%-CI 0.28-1.00, p = 0.05). For subgroup 1, having 'any CI nodes without PAO nodes' and local failure significantly increased NF risk. Additionally, elective PAO-irradiation was associated with less risk of NF (HR 0.38, 95%-CI 0.17-0.86, p = 0.02). For subgroup 2 only local failure was associated with higher risk of NF.
In this patient cohort, nodal disease and tumour width at diagnosis, as well as local failure, are risk factors for NF after definitive treatment. Having either 'any PAO nodes' (with or without pelvic nodes) or 'any CI nodes' (without PAO nodes) are stronger risk factors than involvement of nodes in the small pelvis alone. Elective PAO-irradiation was associated with significantly less NF, particularly in patients with nodal disease in the 'small pelvis' and/or CI region at time of diagnosis.
评估 EMBRACE I 研究中接受根治性（放化疗）和图像引导近距离放疗的局部晚期宫颈癌（LACC）患者发生淋巴结失败（NF）的危险因素。
分析了盆腔 NF 和主动脉旁（PAO）NF（NF）的数据。经过多次插补后，对临床和治疗相关变量进行单变量和多变量 Cox 回归分析。对于诊断时仅累及盆腔淋巴结而无 PAO 淋巴结的患者，进一步对两个亚组进行了分析：1. 髂内、外、闭孔、宫旁、直肠前和/或髂总（CI）区的“小骨盆”淋巴结；2. 任何 CI 淋巴结（亚组 1）。
共分析了 1338 例患者的 152 例 NF 和 104 例 NF 事件，中位随访时间为 34.2 个月（IQR 16.4-52.7）。对于整个组，较大的肿瘤宽度、淋巴结危险组（特别是无 PAO 淋巴结的任何 CI 淋巴结）、局部失败和较低的 Hb 最低值增加了 NF 的风险。选择性 PAO 照射与 NF 风险降低独立相关（HR 0.53，95%-CI 0.28-1.00，p=0.05）。对于亚组 1，“任何无 PAO 淋巴结的 CI 淋巴结”和局部失败显著增加 NF 风险。此外，选择性 PAO 照射与 NF 风险降低相关（HR 0.38，95%-CI 0.17-0.86，p=0.02）。对于亚组 2，只有局部失败与 NF 风险增加相关。
在该患者队列中，诊断时的淋巴结疾病和肿瘤宽度以及局部失败是根治性治疗后 NF 的危险因素。存在“任何 PAO 淋巴结”（伴或不伴盆腔淋巴结）或“任何 CI 淋巴结”（无 PAO 淋巴结）是比“小骨盆”淋巴结受累更强的危险因素。选择性 PAO 照射与 NF 显著减少相关，尤其是在诊断时存在“小骨盆”和/或 CI 区域淋巴结疾病的患者。
