Kim Catherine, Salvo Gloria, Ishikawa Mitsuya, Chen Tze-Chien, Jhingran Anuja, Bhosale Priya, Ramalingam Preetha, Frumovitz Michael
Inova Fairfax Hospital, Obstetrics and Gynecology, Falls Church, VA, USA.
Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Gynecol Oncol. 2023 Mar;170:328-332. doi: 10.1016/j.ygyno.2023.01.036. Epub 2023 Feb 9.
Neuroendocrine carcinoma of the cervix (NECC) is an aggressive disease with high rates of nodal disease spread even in seemingly cervix-confined disease. Many providers routinely prescribe postoperative radiation therapy in an effort to reduce recurrences despite a lack of supporting studies. The objective of this study was to determine recurrence and mortality in patients with early-stage NECC who had pelvic radiation after radical hysterectomy compared to those who did not receive radiation.
We performed a meta-analysis of 13 unique studies that reported recurrence and/or mortality for patients with early-stage NECC who underwent radical hysterectomy with or without adjuvant radiation therapy.
In 5 studies that reported overall recurrence rates, 63 (52.5%) of 120 patients who received postoperative radiation recurred compared to 70 (37.8%) of 185 patients who did not (RR 1.21, 95% CI: 0.85-1.70, p = 0.29). In 5 studies that reported pelvic recurrence rates, there were 15 pelvic recurrences (12.5%) in the 120 patients who received postoperative radiation compared to 45 pelvic recurrences (24.3%) in the 185 patients who did not (RR 0.60, 95% CI: 0.34-1.08, p = 0.09). In 13 studies that reported mortality rate, there were 138 deaths (34.8%) in 396 patients who received postoperative radiation therapy compared to 223 (35.2%) in 632 patients who did not (RR 1.08, 95% CI: 0.75-1.56, p = 0.66).
The addition of routine postoperative radiation therapy in all patients with early-stage NECC after radical hysterectomy may reduce pelvic recurrences but does not appear to decrease overall recurrence or death. However, there may still be a role for postoperative radiation therapy in patients with additional high-risk pathologic factors.
宫颈神经内分泌癌（NECC）是一种侵袭性疾病，即使在看似局限于宫颈的疾病中，淋巴结转移率也很高。尽管缺乏支持性研究，但许多医疗人员仍常规开具术后放射治疗处方，以努力降低复发率。本研究的目的是确定与未接受放疗的早期NECC患者相比，接受根治性子宫切除术后盆腔放疗的患者的复发率和死亡率。
我们对13项独特的研究进行了荟萃分析，这些研究报告了接受或未接受辅助放疗的根治性子宫切除术的早期NECC患者的复发率和/或死亡率。
在5项报告总体复发率的研究中，120例接受术后放疗的患者中有63例（52.5%）复发，而185例未接受放疗的患者中有70例（37.8%）复发（风险比1.21，95%置信区间：0.85 - 1.70，p = 0.29）。在5项报告盆腔复发率的研究中，120例接受术后放疗的患者中有15例盆腔复发（12.5%），而185例未接受放疗的患者中有45例盆腔复发（24.3%）（风险比0.60，95%置信区间：0.34 - 1.08，p = 0.09）。在13项报告死亡率的研究中，396例接受术后放疗的患者中有138例死亡（34.8%），而632例未接受放疗的患者中有223例死亡（35.2%）（风险比1.08，95%置信区间：0.75 - 1.56，p = 0.66）。
在根治性子宫切除术后对所有早期NECC患者常规加用术后放疗可能会降低盆腔复发率，但似乎不会降低总体复发率或死亡率。然而，对于有其他高危病理因素的患者，术后放疗可能仍有作用。
