Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No.277, West Yanta Road, Xi'an, Shaanxi, 710000, People's Republic of China.
Department of Radiation Oncology, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, People's Republic of China.
World J Surg Oncol. 2022 Nov 28;20(1):372. doi: 10.1186/s12957-022-02820-x.
Adjuvant chemoradiotherapy (CRT) has been shown to reduce the risk of recurrence for patients with risk factors after radical hysterectomy (RH). Early initiated CRT could result in superior oncological outcomes. Here, we aimed to compare the survival outcome of intermediate- or high-risk cervical cancer (CC) patients who, received adjuvant CRT between minimally invasive surgery (MIS) and open surgery.
Data on stage IB1-IIA2 patients who underwent RH and postoperative CRT in our institution, from 2014 to 2017, were retrospectively collected. Patients with high or intermediate-risk factors who met the Sedlis criteria received sequential chemoradiation (SCRT). According to the surgical approaches, the enrolled patients were divided into MIS and open surgery groups. Then, the disease-free survival (DFS), overall survival (OS), and prognostic factors were analyzed.
Among 129 enrolled CC patients, 68 received open surgery and 61 received MIS. The median time interval from surgery to chemotherapy and to radiotherapy was shorter in the MIS group (7 days vs. 8 days, P=0.014; 28 days vs. 35, P<0.001). Three-year DFS and OS were similar in both groups (85.2% vs. 89.7%, P=0.274; 89.9% vs. 98.5%, P=0.499). Further, sub-analysis indicated that the DFS and OS in intermediate/high-risk groups had no significant difference. Cox-multivariate analyses found that tumor size >4 cm and time interval from surgery to radiotherapy beyond 7 weeks were adverse independent prognostic factors for DFS.
Based on the population we studied, for early-stage (IB1-IIA2) CC patients with intermediate- or high-risk factors who received postoperative SCRT, although the difference was not significant, the DFS and OS in the MIS group were slightly lower than the ORH group, and tumor size >4 cm and delayed adjuvant radiotherapy beyond 7 weeks were risk factors for recurrence.
辅助放化疗（CRT）已被证明可降低根治性子宫切除术（RH）后具有危险因素的患者的复发风险。早期开始的 CRT 可能会带来更好的肿瘤学结果。在这里，我们旨在比较接受微创外科（MIS）和开腹手术的中高危宫颈癌（CC）患者接受辅助 CRT 的生存结果。
回顾性收集了 2014 年至 2017 年在我院接受 RH 及术后 CRT 的 IB1-IIA2 期患者的数据。符合 Sedlis 标准的具有高危或中危因素的患者接受序贯放化疗（SCRT）。根据手术方式，将入组患者分为 MIS 和开腹手术组。然后分析无病生存率（DFS）、总生存率（OS）和预后因素。
在 129 例 CC 患者中，68 例接受开腹手术，61 例接受 MIS。MIS 组化疗和放疗的手术间隔时间更短（7 天 vs. 8 天，P=0.014；28 天 vs. 35 天，P<0.001）。两组 3 年 DFS 和 OS 相似（85.2% vs. 89.7%，P=0.274；89.9% vs. 98.5%，P=0.499）。进一步的亚分析表明，中高危组的 DFS 和 OS 无显著差异。Cox 多因素分析发现，肿瘤大小>4cm 和手术至放疗时间间隔超过 7 周是 DFS 的不良独立预后因素。
基于我们研究的人群，对于接受术后 SCRT 的早期（IB1-IIA2）CC 患者，中高危因素患者，MIS 组的 DFS 和 OS 略低于 ORH 组，肿瘤大小>4cm 和辅助放疗延迟 7 周以上是复发的危险因素。
