Bukkems Leslie J H, Jürgenliemk-Schulz Ina M, van der Leij Femke, Peters Max, Gerestein Cornelis G, Zweemer Ronald P, van Rossum Peter S N
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Clin Transl Radiat Oncol. 2022 May 30;35:97-103. doi: 10.1016/j.ctro.2022.05.006. eCollection 2022 Jul.
Patients with locally advanced cervical cancer without para-aortic lymph node metastases (PAO-LNM) at diagnosis who undergo concurrent chemoradiotherapy are at 4-11% risk of developing PAO-LNM during follow-up. Some studies suggest a beneficial influence of elective para-aortic radiotherapy (PAO-RT) on disease-free survival (DFS) in these patients. The aim of this study was to systematically review and meta-analyse literature on the impact of PAO-RT on DFS in cervical cancer patients.
A systematic search of PubMed/MEDLINE and EMBASE databases was performed. The analysis included intervention studies that reported on DFS in patients with cervical cancer who received chemotherapy and pelvic radiotherapy with or without PAO-RT. From each included study, relevant study characteristics and outcome data including the hazard ratio (HR) adjusted for potential confounders were extracted. An overall pooled adjusted hazard ratio (aHR) for DFS after PAO-RT versus no PAO-RT was calculated using a random-effects model.
A total of 2,016 articles were evaluated. Eleven articles were included in the systematic review, of which 3 were appropriate for quantitative meta-analysis. Pooling of these 3 cohorts (including 1,113 patients) demonstrated a statistically significant association between PAO-RT and DFS (pooled aHR 0.87, 95% confidence interval: 0.79-0.97). No significant heterogeneity among reported aHRs was observed (I = 0.0%).
This meta-analysis suggests a modest but significant beneficial impact of elective para-aortic radiotherapy on DFS in patients with locally advanced cervical cancer who undergo concurrent chemoradiotherapy. This finding based on non-randomized studies provides an imperative for further investigation in prospective controlled trials.
诊断时无腹主动脉旁淋巴结转移（PAO-LNM）的局部晚期宫颈癌患者接受同步放化疗后，在随访期间发生PAO-LNM的风险为4%-11%。一些研究表明，选择性腹主动脉旁放疗（PAO-RT）对这些患者的无病生存期（DFS）有有益影响。本研究的目的是系统评价和荟萃分析关于PAO-RT对宫颈癌患者DFS影响的文献。
对PubMed/MEDLINE和EMBASE数据库进行系统检索。分析纳入了报告接受化疗和盆腔放疗（有或无PAO-RT）的宫颈癌患者DFS的干预性研究。从每项纳入研究中，提取相关研究特征和结局数据，包括针对潜在混杂因素调整后的风险比（HR）。使用随机效应模型计算PAO-RT与未进行PAO-RT相比DFS的总体合并调整后风险比（aHR）。
共评估了2016篇文章。11篇文章纳入系统评价，其中3篇适合进行定量荟萃分析。对这3个队列（共1113例患者）进行汇总分析，结果显示PAO-RT与DFS之间存在统计学显著关联（合并aHR为0.87，95%置信区间：0.79-0.97）。各报告的aHR之间未观察到显著异质性（I² = 0.0%）。
这项荟萃分析表明，选择性腹主动脉旁放疗对接受同步放化疗的局部晚期宫颈癌患者的DFS有适度但显著的有益影响。基于非随机研究的这一发现为进一步开展前瞻性对照试验提供了必要性。
