Zhou Fang, Tang Xuedong, Shao Zhuyan, Chen Xi, Gao Wen, Fang Chenyan, Wang Zejia, Zhang Ping, Zhu Tao, Tang Huarong
Department of Gynecological Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
School of the Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Front Oncol. 2022 Sep 23;12:948298. doi: 10.3389/fonc.2022.948298. eCollection 2022.
We aimed to evaluate survival, complications, and prognostic factors in patients with IB2/IIA2 (FIGO 2009, bulky early-stage) cervical cancer (CC) who were primarily treated with radical surgery (RS).
From January 2011 to January 2018, patients with stage IB2/IIA2 CC who underwent RS ± adjuvant therapy were enrolled and retrospectively evaluated. Survival was estimated using the Kaplan-Meier method. Significance was determined using the log-rank test. Multivariate regression analyses were performed to determine prognostic factors.
Of the 975 enrolled patients, 877 (89.9%) received adjuvant therapy. The median follow-up was 48 months, the 5-year overall survival (OS) was 85.9%, and the 5-year progression-free survival (PFS) rate was 80.8%. Multivariate analysis showed that histological type, pelvic lymph nodes, and para-aortic lymph nodes were independent prognostic factors for PFS and OS. Tumor diameter was also an independent prognostic factor with OS. Recurrent disease developed in 14.3% (140) of patients., including local, distant, and both recurrences in 55 (5.6%), 71 (7.3%), and 14 (1.4%) patients, respectively. Grade 3-4 short-term complications occurred in 196 (20.1%) patients, and long-term complications occurred in 86 (8.8%) patients. Short-term hematological complications occurred in 99 cases (10.2%). No significant differences in non-hematological complications were detected between the RS and RS + adjuvant therapy groups.
RS followed by adjuvant therapy is a feasible and effective treatment for IB2/IIA2 CC, with a high 5-year survival rate and an acceptable incidence of complications. Positive pelvic lymph nodes and para-aortic abdominal lymph nodes significantly impact PFS and OS. Evaluation of lymph node status before surgery is important. RS is recommended for patients with negative lymph node metastasis.
我们旨在评估主要接受根治性手术（RS）治疗的IB2/IIA2期（国际妇产科联盟2009年版，早期大体积）宫颈癌（CC）患者的生存率、并发症及预后因素。
纳入2011年1月至2018年1月期间接受RS±辅助治疗的IB2/IIA2期CC患者，并进行回顾性评估。采用Kaplan-Meier法估计生存率。使用对数秩检验确定显著性。进行多因素回归分析以确定预后因素。
在975例纳入患者中，877例（89.9%）接受了辅助治疗。中位随访时间为48个月，5年总生存率（OS）为85.9%，5年无进展生存率（PFS）为80.8%。多因素分析显示，组织学类型、盆腔淋巴结及腹主动脉旁淋巴结是PFS和OS的独立预后因素。肿瘤直径也是OS的独立预后因素。14.3%（140例）患者出现复发疾病，其中局部复发、远处复发及两者均复发的患者分别为55例（5.6%）、71例（7.3%）和14例（1.4%）。196例（20.1%）患者发生3-4级短期并发症，86例（8.8%）患者发生长期并发症。短期血液学并发症发生99例（10.2%）。RS组与RS+辅助治疗组在非血液学并发症方面未检测到显著差异。
RS联合辅助治疗是IB2/IIA2期CC可行且有效的治疗方法，5年生存率高，并发症发生率可接受。盆腔淋巴结阳性和腹主动脉旁淋巴结阳性对PFS和OS有显著影响。术前评估淋巴结状态很重要。推荐对淋巴结转移阴性的患者行RS。
