Park Sunmin, Park Won, Park Shin Hyung, Kim Joo-Young, Kim Jin Hee, Kim Haeyoung, Kim Yeon-Sil, Cho Won Kyung, Yoon Won Sup, Yang Dae Sik
Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea.
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Gynecol Oncol. 2022 May;33(3):e32. doi: 10.3802/jgo.2022.33.e32. Epub 2022 Feb 3.
This study aimed to evaluate the oncologic outcomes according to disease burden in uterine cervical cancer patients with metachronous distant metastases.
Between 2005 and 2015, 163 patients with metachronous distant metastases from uterine cervical cancer after receiving a definitive therapy were evaluated at seven institutions in Korea. Low metastatic burden was defined as less than 5 metastatic sites, whereas high metastatic burden was others. Each metastasis site was divided based on the lymph node (LN) and organs affected. The overall survival (OS) and progression-free survival (PFS) were assessed. Cox proportional hazards models, including other clinical variables, were used to evaluate the survival outcomes.
The median follow-up duration was 22.2 months (range: 0.3-174.8 months). Para-aortic LNs (56.4%), lungs (26.4%), supraclavicular LNs (18.4%), and peritoneum (13.5%) were found to be the common metastasis sites. Among 37 patients with a single metastasis, 17 (45.9%) had LN metastases and 20 (54.1%) had organ metastases. The 1- and 2-year OS rates were 73.9% and 55.0%, respectively, whereas the PFS rates were 67.2% and 42.9%, respectively. SCC Ag after recurrence and high metastatic burden were significant factors affecting the OS (p=0.004 and p<0.001, respectively). Distant organ recurrence, short disease-free interval (≤2 years), and high metastatic burden were unfavorable factors for PFS (p=0.003, p=0.011, and p=0.002, respectively).
A favorable oncologic outcome can be expected by performing salvage treatments in selected patients with a long disease-free interval, low metastatic burden, and/or lymphatic-only metastasis.
本研究旨在评估异时性远处转移的子宫颈癌患者根据疾病负担的肿瘤学结局。
2005年至2015年期间，韩国7家机构对163例接受确定性治疗后出现异时性远处转移的子宫颈癌患者进行了评估。低转移负担定义为转移部位少于5个，而高转移负担则为其他情况。每个转移部位根据受影响的淋巴结（LN）和器官进行划分。评估总生存期（OS）和无进展生存期（PFS）。使用包括其他临床变量的Cox比例风险模型来评估生存结局。
中位随访时间为22.2个月（范围：0.3 - 174.8个月）。发现主动脉旁淋巴结（56.4%）、肺（26.4%）、锁骨上淋巴结（18.4%）和腹膜（13.5%）是常见的转移部位。在37例单一转移患者中，17例（45.9%）有淋巴结转移，20例（54.1%）有器官转移。1年和2年总生存率分别为73.9%和55.0%，而无进展生存率分别为67.2%和42.9%。复发后鳞状细胞癌抗原（SCC Ag）和高转移负担是影响总生存期的重要因素（分别为p = 0.004和p < 0.001）。远处器官复发、短无病间期（≤2年）和高转移负担是无进展生存期的不利因素（分别为p = 0.003、p = 0.011和p = 0.002）。
对于无病间期长、转移负担低和/或仅为淋巴转移的特定患者，通过进行挽救性治疗有望获得良好的肿瘤学结局。
