新辅助化疗后行根治性手术可降低 IB2 期至 IIA2 期宫颈癌患者的放疗需求。

Neoadjuvant chemotherapy followed by radical surgery reduces radiation therapy in patients with stage IB2 to IIA2 cervical cancer.

机构信息

Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.

出版信息

World J Surg Oncol. 2022 Aug 23;20(1):264. doi: 10.1186/s12957-022-02731-x.

DOI:10.1186/s12957-022-02731-x

PMID:35996118

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9396822/

Abstract

BACKGROUND

To investigate whether carboplatin-liposomal paclitaxel neoadjuvant chemotherapy (NACT) benefits patients with locally advanced cervical cancer (LACC) through avoiding or delaying postoperative radiation.

METHODS

A total of 414 patients with cervical cancer of International Federation of Gynecology and Obstetrics (FIGO 2009) stages IB2-IIA2 were included in the retrospective cohort study, who had received carboplatin-liposomal paclitaxel chemotherapy followed by radical surgery (NACT group) or primary radical surgery (PRS group) between 2007 and 2017 at our hospital. The baseline clinicopathological characteristics at diagnosis, postoperative pathological risk factors, and oncological outcomes after surgery, including postoperative radiation (as adjuvant treatment or treatment of recurrent diseases), progression-free survival (PFS), and overall survival (OS), were compared between the groups. Before treatment, the patients in the NACT group had significantly more advanced tumor stages and larger tumor sizes than those in the PRS group.

RESULTS

The NACT reduced the tumor volumes remarkedly with a response rate of 62.4%, and the tumors in the NACT group were smaller than those in the PRS group when the patients were subjected to radical surgery. Furthermore, postoperative pathology examination revealed less frequent deep stromal invasion in the NACT group than in the PRS group. According to the presence of pathological risk factors for recurrence, 54.82% of women in the NACT group needed adjuvant radiotherapy, while 60.87% in the PRS group, and in fact, 33.00% of NACT patients and 40.09% of PRS patients received adjuvant radiation. In addition, 8.12% of NACT patients and 9.68% of PRS patients underwent radiotherapy after relapse. The cumulative postoperative radiation rate was significantly lower in the NACT group (P = 0.041), while the differences in 5-year OS and PFS were not statistically significant between the groups.

CONCLUSIONS

NACT reduces the pathological risk factors and the use of radiation without compromising survival in patients with LACC, which may protect younger patients from radiation-related side effects and subsequently improve the quality of life.

TRIAL REGISTRATION

ISRCTN Registry, ISRCTN24104022.

摘要

背景

为了探讨卡铂脂质体紫杉醇新辅助化疗（NACT）是否通过避免或延迟术后放疗使局部晚期宫颈癌（LACC）患者受益。

方法

回顾性队列研究纳入了 2007 年至 2017 年在我院接受卡铂脂质体紫杉醇化疗后行根治性手术（NACT 组）或直接根治性手术（PRS 组）的国际妇产科联合会（FIGO 2009）分期为 IB2-IIA2 的 414 例宫颈癌患者。比较两组患者的基线临床病理特征、术后病理危险因素以及术后的肿瘤学结局，包括术后放疗（作为辅助治疗或治疗复发病例）、无进展生存期（PFS）和总生存期（OS）。在治疗前，NACT 组患者的肿瘤分期和肿瘤体积明显更晚和更大。

结果

NACT 使肿瘤体积显著缩小，缓解率为 62.4%，NACT 组患者行根治性手术后肿瘤体积小于 PRS 组。此外，术后病理检查发现 NACT 组患者的深肌层浸润较 PRS 组少见。根据复发的病理危险因素，NACT 组有 54.82%的患者需要辅助放疗，PRS 组为 60.87%，实际上，NACT 组中有 33.00%和 PRS 组中有 40.09%的患者接受了辅助放疗。此外，NACT 组有 8.12%和 PRS 组有 9.68%的患者在复发后接受了放疗。NACT 组的术后放疗累积率显著降低（P=0.041），但两组患者的 5 年 OS 和 PFS 差异无统计学意义。