Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, People's Republic of China.
Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, People's Republic of China.
Gynecol Oncol. 2022 Jun;165(3):538-545. doi: 10.1016/j.ygyno.2022.04.013. Epub 2022 Apr 27.
To evaluate the value of local treatment in stage IVB cervical cancer (CC).
Patients diagnosed with stage IVB CC between 2010 and 2015 were included using the data from the Surveillance, Epidemiology, and End Results program. Propensity score matching (PSM) was used to balance the clinicopathological variables of patients. Multivariate Cox regression analyses were performed to analyze the risk factors associated with cause-specific survival (CSS).
We identified 960 patients in this study, all patients had received chemotherapy. Of these patients, 818 patients were treated with local treatment (85.2%), including 724 (88.5%) and 94 (11.5%) patients receiving radiotherapy (RT) alone and surgery ± RT, respectively. Local treatment was the independent prognostic factor associated with better CSS. Before PSM, patients who received RT (hazard ratio [HR] 0.633, 95% confidence interval [CI] 0.517-0.775, P < 0.001) or surgery (HR 0.391, 95% CI 0.277-0.552, P < 0.001) were independently associated with a better CSS compared to those with no local treatment. The 3-years CSS rate was 14.4%, 32.4%, and 54.8% in no local treatment, RT alone, and surgery groups, respectively (P < 0.001). Similar results were found after PSM. Patients receiving RT (HR 0.643, 95% CI 0.436-0.947, P = 0.025) and surgery (HR 0.146, 95% CI 0.052-0.410, P < 0.001) had better CSS compared to patients with no local treatment after PSM. While similar CSS was shown between RT alone cohort and the surgery cohort (HR 0.756, 95% CI 0.454-1.260, P = 0.284).
The addition of local surgery or RT to chemotherapy appears to confer improved survival outcomes in patients with stage IVB CC.
评估局部治疗在 IVB 期宫颈癌（CC）中的价值。
采用监测、流行病学和最终结果（SEER）数据库，选取 2010 年至 2015 年间诊断为 IVB 期 CC 的患者，采用倾向评分匹配（PSM）平衡患者的临床病理变量，采用多因素 Cox 回归分析与特定原因生存（CSS）相关的危险因素。
本研究共纳入 960 例患者，所有患者均接受了化疗。其中 818 例患者接受了局部治疗（85.2%），包括单纯放疗（RT）724 例（88.5%）和手术+RT 94 例（11.5%）。局部治疗是与更好的 CSS 相关的独立预后因素。在 PSM 之前，与未接受局部治疗的患者相比，接受 RT（风险比 [HR]0.633，95%置信区间 [CI]0.517-0.775，P<0.001）或手术（HR0.391，95%CI0.277-0.552，P<0.001）的患者 CSS 更好。未接受局部治疗、单纯 RT 和手术组的 3 年 CSS 率分别为 14.4%、32.4%和 54.8%（P<0.001）。PSM 后也得到了类似的结果。与未接受局部治疗的患者相比，接受 RT（HR0.643，95%CI0.436-0.947，P=0.025）和手术（HR0.146，95%CI0.052-0.410，P<0.001）的患者 CSS 更好。虽然 RT 组与手术组的 CSS 相似（HR0.756，95%CI0.454-1.260，P=0.284）。
在化疗的基础上加用局部手术或 RT 似乎能改善 IVB 期 CC 患者的生存结局。
