Shi Feiya, Yoder Alison K, Mach Claire, Dalwadi Shraddha, Anderson Matthew L, Hall Tracilyn R, Ludwig Michelle S
Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA.
Department of Radiation Oncology, University of Texas Health Science Center at Houston McGovern School of Medicine, Houston, TX, USA.
Obstet Gynecol Sci. 2022 Mar;65(2):176-187. doi: 10.5468/ogs.21308. Epub 2022 Feb 22.
To evaluate the prognostic significance of hematological toxicities during cervical cancer treatment.
Patients treated for cervical carcinoma with definitive chemoradiation were identified. Toxicities were assessed during weeks 1 to 6 of concurrent external beam radiation and chemotherapy. Outcomes were analyzed using Cox regression analysis.
One hundred twenty-one patients with Federation of Gynecology and Obstetrics stage I-III disease were eligible for analysis. Median age at diagnosis was 45 years (interquartile range, 40-52) with median follow-up time of 34 months (95% confidence interval, 30.8-37.2). All patients experienced some grade of hematologic toxicity. The most common grade 3+ toxicities were low absolute lymphocyte count (n=115, 95%), low white blood cell count (n=21, 17%), and anemia (n=11, 9%). The most common grade 4 toxicity was lymphopenia, experienced by 36% of patients (n=44). Grade 4 lymphopenia was associated with reduced overall survival (hazard ratio [HR], 4.5; P=0.005), progression-free survival (HR, 3.4; P=0.001), and local control (HR, 4.1; P=0.047). Anemia grade 3, 4 was also associated with reduced overall survival (HR, 4.1; P=0.014). After controlling for disease and treatment variables, grade 4 lymphopenia remained significantly associated with reduced overall survival (HR, 9.85; P=0.007). The association with grade 4 lymphopenia only remained significant in women of Hispanic ethnicity.
Severe lymphopenia was associated with reduced overall survival and progression-free survival in Hispanic women undergoing definitive chemoradiation for cervical cancer, but not associated with outcomes in non-Hispanic women.
评估宫颈癌治疗期间血液学毒性的预后意义。
确定接受根治性放化疗的宫颈癌患者。在同步外照射放疗和化疗的第1至6周评估毒性。使用Cox回归分析对结果进行分析。
121例国际妇产科联盟（FIGO）I-III期疾病患者符合分析条件。诊断时的中位年龄为45岁（四分位间距，40-52岁），中位随访时间为34个月（95%置信区间，30.8-37.2）。所有患者均经历了某种程度的血液学毒性。最常见的3级及以上毒性为绝对淋巴细胞计数低（n=115，95%）、白细胞计数低（n=21，17%）和贫血（n=11，9%）。最常见的4级毒性为淋巴细胞减少，36%的患者（n=44）出现该情况。4级淋巴细胞减少与总生存期缩短（风险比[HR]，4.5；P=0.005）、无进展生存期缩短（HR，3.4；P=0.001）和局部控制率降低（HR，4.1；P=0.047）相关。3级、4级贫血也与总生存期缩短相关（HR，4.1；P=0.014）。在控制疾病和治疗变量后，4级淋巴细胞减少仍与总生存期缩短显著相关（HR，9.85；P=0.007）。仅4级淋巴细胞减少与总生存期的关联在西班牙裔女性中仍然显著。
在接受宫颈癌根治性放化疗的西班牙裔女性中，严重淋巴细胞减少与总生存期和无进展生存期缩短相关，但与非西班牙裔女性的预后无关。
