Stanca Mihai, Căpîlna Dan Mihai, Căpîlna Mihai Emil
First Obstetrics and Gynecology Clinic, University of Medicine, Pharmacy, Science and Technology "G.E. Palade" of Târgu Mureș, Gheorghe Marinescu Street, Number 38, 540142 Târgu Mureș, Romania.
Cancers (Basel). 2022 May 9;14(9):2346. doi: 10.3390/cancers14092346.
Background: Considerable efforts have been carried out over the past 30 years to support patients with advanced cervical cancer. Throughout this time, Eastern European countries have been left aside from the decision-making groups on this matter, hence the absence of similar studies in this geographical area. In these countries, the quality of life (QoL) of patients with cervical cancer might be considered a “caprice”, and the discomforts they encounter following pelvic exenteration for cervical cancer are often perceived as a “normal phenomenon”. Methods: This study examined forty-seven patients submitted to pelvic exenteration followed up for nine years after the surgical intervention. The first objective of this study is to identify the prognostic factors that influence the overall survival (OS) of patients undergoing pelvic exenteration for FIGO stage IVA, recurrent or persistent cervical cancer after previous conclusive treatments. The second objective is to assess the QoL of the surviving patients using the QLQ-C30 and QLQ-CX24 standardized questionnaires. Results: The mean age of the participants was 54 years (range 36−67). At the time of the study, there were 25 living patients (53.2%), the 3-year OS was 61%, and the 5-year OS was 48.7%. Cox regression analysis recognized parameter invasion, pelvic lymph node metastases, positive resection margins, early postoperative complications, and infralevatorian pelvic exenteration as negative prognostic factors influencing the OS (p < 0.05). Of the 25 survivors, 18 patients answered the QoL questionnaires. The cost of favorable survival has been translated into poor overall QoL, unsatisfactory functional, social, and symptom scores, a high prevalence of cervical cancer-specific symptoms such as lymphedema, peripheral neuropathy, severe menopausal symptoms, distorted body image, and lack of sexual desire. The lower scores are comparable to the only three studies available in the literature that assessed the QoL of patients undergoing pelvic exenteration precisely for cervical cancer. Conclusions: Despite its retrospective nature and some limitations, this paper, similar to other studies, shows a decent OS but with a marked adverse impact on QoL, suggesting the importance of adequate psycho-emotional and financial support for these patients following pelvic exenteration. This study also contributes to the current knowledge regarding advanced cervical cancer treatment, depicting survival, prognostic factors, and QoL of patients undergoing pelvic exenteration for cervical cancer in a reference center in Eastern Europe. Our study can provide a comparison for future prospective randomized trials needed to confirm these results.
在过去30年里，人们为支持晚期宫颈癌患者付出了巨大努力。在此期间，东欧国家在这一问题的决策群体中被边缘化，因此该地理区域缺乏类似研究。在这些国家，宫颈癌患者的生活质量（QoL）可能被视为一种“任性的要求”，而她们在宫颈癌盆腔脏器清除术后所遭遇的不适往往被视为一种“正常现象”。方法：本研究对47例行盆腔脏器清除术的患者进行了检查，并在手术干预后对其进行了9年的随访。本研究的首要目标是确定影响国际妇产科联盟（FIGO）IVA期、复发性或持续性宫颈癌患者在先前确定性治疗后行盆腔脏器清除术的总生存期（OS）的预后因素。第二个目标是使用QLQ-C30和QLQ-CX24标准化问卷评估存活患者的生活质量。结果：参与者的平均年龄为54岁（范围36 - 67岁）。在研究时，有25名存活患者（53.2%），3年总生存率为61%，5年总生存率为48.7%。Cox回归分析确定参数侵犯、盆腔淋巴结转移、切缘阳性、术后早期并发症和低位盆腔脏器清除术为影响总生存期的负面预后因素（p < 0.05）。在25名幸存者中，18名患者回答了生活质量问卷。良好生存的代价表现为总体生活质量差、功能、社会和症状评分不满意、宫颈癌特异性症状如淋巴水肿、周围神经病变、严重更年期症状、身体形象扭曲和性欲缺乏的高患病率。较低的评分与文献中仅有的三项精确评估宫颈癌盆腔脏器清除术患者生活质量的研究结果相当。结论：尽管本研究具有回顾性且存在一些局限性，但与其他研究类似，它显示出了尚可的总生存期，但对生活质量有显著的不利影响，这表明在盆腔脏器清除术后为这些患者提供充分的心理情感和经济支持的重要性。本研究还为当前关于晚期宫颈癌治疗的知识做出了贡献，描绘了东欧一个参考中心中宫颈癌盆腔脏器清除术患者的生存情况、预后因素和生活质量。我们的研究可为未来需要证实这些结果的前瞻性随机试验提供比较。
