外阴癌辅助放疗与局部复发——AGO-CARE-1 研究的亚组分析。
Adjuvant radiotherapy and local recurrence in vulvar cancer - a subset analysis of the AGO-CaRE-1 study.
机构信息
Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Colposcopy Clinic at the Jerusalem Hospital Hamburg, Hamburg, Germany.
Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Colposcopy Clinic at the Jerusalem Hospital Hamburg, Hamburg, Germany; Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg - Eppendorf, Germany.
出版信息
Gynecol Oncol. 2022 Jan;164(1):68-75. doi: 10.1016/j.ygyno.2021.11.004. Epub 2021 Nov 16.
BACKGROUND
The impact of adjuvant radiotherapy (RT) to the vulva with regard to prognosis and local recurrence in patients with vulvar squamous cell cancer (VSCC) is poorly described.
PATIENTS AND METHODS
In the AGO-CaRE-1 study 1618 patients with primary VSCC FIGO stage ≥ IB, treated between 1998-2008, were documented. In this retrospective subanalysis, 360 patients were included based on the following criteria: nodal involvement (pN+), known RT treatment and known radiation fields.
RESULTS
The majority had pT1b/pT2 tumors (n=299; 83.1%). In 76.7%, R0 resection was achieved. 57/360 (15.8%) N+ patients were treated with adjuvant RT to the groins/pelvis and 146/360 (40.5%) received adjuvant RT to the vulva and groins/pelvis. 157/360 (43.6%) patients did not receive any adjuvant RT. HPV status was available in 162/360 patients (45.0%), 75/162 tumors were HPV+(46.3%), 87/162 (53.7%) HPV-. During a median follow-up of 17.2 months, recurrence at the vulva only occurred in 25.5% of patients without adjuvant RT, in 22.8% of patients with adjuvant RT to groins/pelvis and in 15.8% of patients with adjuvant RT to the vulva and groins/pelvis respectively. The risk reducing effect of local RT was independent of the resection margin status. 50% disease free survival time (50% DFST) indicated a stronger impact of adjuvant RT to the vulva in HPV+ compared to HPV- patients (50% DFST 20.7 months vs. 17.8 months).
CONCLUSION
Adjuvant RT to the vulva was associated with a lower risk for local recurrence in N+ VSCC independent of the resection margin status. This observation was more pronounced in patients with HPV+ tumors in comparison to HPV- tumors.
背景
辅助放疗（RT）对外阴预后和局部复发的影响在外阴鳞状细胞癌（VSCC）患者中描述甚少。
患者和方法
在 AGO-CaRE-1 研究中，共记录了 1998 年至 2008 年间治疗的 1618 例原发性 VSCCFIGO 分期≥IB 的患者。在本回顾性亚分析中，根据以下标准纳入了 360 例患者：淋巴结受累（pN+）、已知的 RT 治疗和已知的照射野。
结果
大多数患者的肿瘤为 T1b/T2（n=299；83.1%）。76.7%的患者达到了 R0 切除。57/360（15.8%）的 N+患者接受了腹股沟/盆腔辅助 RT，146/360（40.5%）接受了外阴和腹股沟/盆腔辅助 RT。157/360（43.6%）的患者未接受任何辅助 RT。360 例患者中有 162 例（45.0%）可获得 HPV 状态，其中 75 例（46.3%）HPV+，87 例（53.7%）HPV-。中位随访 17.2 个月时，未接受辅助 RT 的患者中仅 25.5%、接受腹股沟/盆腔辅助 RT 的患者中 22.8%、接受外阴和腹股沟/盆腔辅助 RT 的患者中 15.8%发生外阴局部复发。局部 RT 的降低风险作用独立于切缘状态。50%无疾病生存时间（50%DFST）表明，HPV+患者中外阴辅助 RT 的影响强于 HPV-患者（50%DFST 20.7 个月比 17.8 个月）。
结论
在 N+ VSCC 患者中，外阴辅助 RT 与局部复发风险降低相关，与切缘状态无关。与 HPV-肿瘤相比，HPV+肿瘤患者的这一观察结果更为明显。
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