Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
Gynecol Oncol. 2022 Jun;165(3):530-537. doi: 10.1016/j.ygyno.2022.03.022. Epub 2022 Apr 5.
To evaluate the survival impact of adding definitive pelvic radiation therapy (RT) to chemotherapy among patients with stage IVB neuroendocrine cervical carcinoma (NECC).
We retrospectively studied patients with FIGO 2018 stage IVB NECC diagnosed during 1998-2020 who received chemotherapy with or without definitive whole pelvic RT (concurrent or sequential). Demographic, oncologic, and treatment characteristics were summarized. Progression-free (PFS) and overall survival (OS) were plotted using the Kaplan-Meier method, and hazard ratios (HRs) were calculated using Cox regression.
The study included 71 patients. Median age was 43 years (range, 24-75). Fifty-nine patients (83%) had pure neuroendocrine histology, and 57 (80%) had pretreatment tumor size >4 cm. Fifty-six patients (79%) received chemotherapy alone with (n = 15) or without (n = 41) palliative pelvic RT, and 15 (21%) received chemotherapy and definitive pelvic RT (chemo+RT). Median follow-up time was 20.1 months (range, 11.3-170.3) for the chemo+RT group and 13.5 months (range, 0.9-73.6) for the chemotherapy-alone group. Median PFS was 10.3 months (95% CI, 7.5-∞) for the chemo+RT group vs 6.6 months (95% CI, 6.1-8.7) for the chemotherapy-alone group (p = 0.0097). At 24 months, the PFS rate was 24% for chemo+RT vs 7.8% for chemotherapy alone. Median OS was 20.3 months (95% CI, 18.5-∞) for the chemo+RT group vs 13.6 months (95% CI, 11.3-19.2) for the chemotherapy-alone group (p = 0.0013). At 24 months, the OS rate was 49.2% for chemo+RT vs 21.5% for chemotherapy alone. In a Cox regression model, definitive RT was associated with improved PFS (HR, 0.44; 95% CI, 0.23-0.83; p = 0.0119) and OS (HR, 0.31; 95% CI, 0.14-0.65; p = 0.0022).
Addition of definitive pelvic RT to chemotherapy may improve survival in patients with stage IVB NECC.
评估在 IVB 期神经内分泌宫颈癌（NECC）患者中，加用根治性盆腔放疗（RT）对化疗的生存影响。
我们回顾性研究了 1998 年至 2020 年期间诊断为国际妇产科联盟（FIGO）2018 年 IVB 期 NECC 的患者，这些患者接受了含或不含根治性全盆腔 RT（同期或序贯）的化疗。总结了人口统计学、肿瘤学和治疗特征。使用 Kaplan-Meier 方法绘制无进展生存（PFS）和总生存（OS）曲线，并使用 Cox 回归计算风险比（HR）。
研究纳入了 71 例患者。中位年龄为 43 岁（范围，24-75 岁）。59 例患者（83%）有纯神经内分泌组织学，57 例患者（80%）治疗前肿瘤直径＞4cm。56 例患者（79%）单独接受化疗，其中 15 例（21%）接受了含或不含姑息性盆腔 RT 的化疗（n=15），15 例（21%）接受了化疗和根治性盆腔 RT（chemo+RT）。chemo+RT 组的中位随访时间为 20.1 个月（范围，11.3-170.3），化疗组为 13.5 个月（范围，0.9-73.6）。chemo+RT 组的中位 PFS 为 10.3 个月（95%CI，7.5-∞），化疗组为 6.6 个月（95%CI，6.1-8.7）（p=0.0097）。在 24 个月时，chemo+RT 组的 PFS 率为 24%，化疗组为 7.8%。chemo+RT 组的中位 OS 为 20.3 个月（95%CI，18.5-∞），化疗组为 13.6 个月（95%CI，11.3-19.2）（p=0.0013）。在 24 个月时，chemo+RT 组的 OS 率为 49.2%，化疗组为 21.5%。在 Cox 回归模型中，根治性 RT 与改善的 PFS（HR，0.44；95%CI，0.23-0.83；p=0.0119）和 OS（HR，0.31；95%CI，0.14-0.65；p=0.0022）相关。
在 IVB 期 NECC 患者中，加用根治性盆腔 RT 联合化疗可能改善生存。
