Chen Fangjie, Chen Long, Zhang Yu, Shi Lei, Xu Hong'en, Song Tao
Department of Outpatient Nursing, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
Graduate School, Zhejiang Chinese Medical University, Hangzhou, China.
Front Oncol. 2022 Jul 22;12:895122. doi: 10.3389/fonc.2022.895122. eCollection 2022.
To compare the prognostic significance of adenocarcinoma (AC) with squamous cell carcinoma (SCC) on overall survival (OS) in patients with stage IIB-IVA cervical cancer (CC) treated by external beam radiotherapy (EBRT) and brachytherapy (BRT) with/without chemotherapy registered in the Surveillance, Epidemiology, and End Results database.
Data of eligible patients were extracted between 2004 and 2016. A univariate analysis was conducted using the cumulative incidence function (CIF) by considering competing events and compared using Gray's test. The significant variables in univariate analysis were further evaluated in a multivariate analysis performed with the Fine-Gray regression model. Propensity score matching (PSM) analysis was also employed to reconfirm the results found in the present study.
A total of 2,243 patients with SCC and 176 patients with AC were extracted from the database. The 5-year OS rates were 57.8% in the SCC group and 52.8% in the AC group. 149 patients died of causes other than CC-considered as competing events. Compared with the SCC group, patients diagnosed with AC had statistically significant worse 5-year OS rate before and after PSM. In the multivariate Fine-Gray regression model, the histological subtype of AC was proven as an independent prognostic factor associated with poorer OS before [hazard ratio (HR) = 1.340; 95% confidence interval (CI): 1.081-1.660; = 0.007] and after [HR = 1.376; 95% CI: 1.107-1.711; = 0.004] PSM.
The histological subtype of AC is significantly correlated with impaired OS as an independent prognostic variable in patients with stage IIB-IVA CC who received EBRT and BRT compared to patients with SCC. Future studies should incorporate effective and individualized treatment strategies into clinical decision-making to improve the unsatisfactory survival outcomes for patients with AC.
比较在监测、流行病学和最终结果数据库中登记的接受外照射放疗（EBRT）和近距离放疗（BRT）联合或不联合化疗治疗的IIB-IVA期宫颈癌（CC）患者中，腺癌（AC）与鳞状细胞癌（SCC）对总生存期（OS）的预后意义。
提取2004年至2016年符合条件患者的数据。采用累积发病率函数（CIF）进行单因素分析，考虑竞争事件并使用Gray检验进行比较。单因素分析中的显著变量在使用Fine-Gray回归模型进行的多因素分析中进一步评估。倾向评分匹配（PSM）分析也用于再次确认本研究的结果。
从数据库中提取了2243例SCC患者和176例AC患者。SCC组的5年总生存率为57.8%，AC组为52.8%。149例患者死于CC以外的原因，被视为竞争事件。与SCC组相比，诊断为AC的患者在PSM前后的5年总生存率在统计学上显著更差。在多因素Fine-Gray回归模型中，AC的组织学亚型被证明是与较差总生存期相关的独立预后因素，在PSM前[风险比（HR）=1.340；95%置信区间（CI）：1.081-1.660；P=0.007]和PSM后[HR=1.376；95%CI：1.107-1.711；P=0.004]。
与SCC患者相比，在接受EBRT和BRT的IIB-IVA期CC患者中，AC的组织学亚型作为独立预后变量与总生存期受损显著相关。未来的研究应将有效和个体化的治疗策略纳入临床决策，以改善AC患者不尽人意的生存结局。
