Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Midwifery, Faculty of Health, Dongguan Polytechnic, Dongguan, China.
J Obstet Gynaecol Res. 2023 Jun;49(6):1579-1591. doi: 10.1111/jog.15632. Epub 2023 Mar 14.
To compare survival outcomes of different postoperative adjuvant therapies (PATs) for early-stage cervical cancer (ECC) patients with one intermediate-risk pathological factor (IPF).
A total of 2889 patients with stage IA1 to IIA2 cervical cancer were included in this study. Three PAT groups were identified, namely a no adjuvant therapy (NAT) group (n = 773), an adjuvant radiotherapy/chemoradiotherapy (ART) group (n = 1648) and an adjuvant chemotherapy (ACT) group (n = 468). Kaplan-Meier analysis and COX regression analysis were used to compare the overall survival (OS) and disease-free survival (DFS) among the three groups, before and after propensity score matching (PSM).
The recurrence and mortality rate rates in the NAT, ART and ACT groups were 9.2%, 8.6%, and 7.9%, respectively (p = 0.737). Kaplan-Meier analysis demonstrated no significant differences in the NAT, ART, and ACT groups in 5-year OS rates (92.8% vs. 93.6% vs. 94.7%, p = 0.594) and DFS rates (88.7% vs. 89.6% vs. 90.5%, p = 0.772). Post-hoc tests yielded similar results, with no differences in 5-year OS and DFS (NAT vs. ART, before and after matching, p > 0.05); (NAT vs. ACT, before and after matching, p > 0.05); and (ACT vs. ART, before and after matching, p > 0.05).
Postoperative adjuvant radiotherapy, chemoradiotherapy, and chemotherapy are not associated with survival outcomes of ECC patients with one IPF. Considering the side effects and impact on patients' quality of life, the PATs should be carefully considered.
比较不同术后辅助治疗（PATs）方案对有 1 个中危病理因素（IPF）的早期宫颈癌（ECC）患者的生存结局。
共纳入 2889 例 IA1 至 IIA2 期宫颈癌患者。本研究将患者分为 3 组，即无辅助治疗（NAT）组（n=773）、辅助放疗/放化疗（ART）组（n=1648）和辅助化疗（ACT）组（n=468）。采用 Kaplan-Meier 分析和 COX 回归分析比较三组患者的总生存（OS）和无病生存（DFS），并在倾向评分匹配（PSM）前后进行比较。
NAT、ART 和 ACT 组的复发率和死亡率分别为 9.2%、8.6%和 7.9%（p=0.737）。Kaplan-Meier 分析显示，三组患者 5 年 OS 率（92.8%比 93.6%比 94.7%，p=0.594）和 DFS 率（88.7%比 89.6%比 90.5%，p=0.772）差异均无统计学意义。事后检验结果也相似，5 年 OS 和 DFS 差异均无统计学意义（NAT 与 ART，匹配前后，p＞0.05）；（NAT 与 ACT，匹配前后，p＞0.05）；（ACT 与 ART，匹配前后，p＞0.05）。
对于有 1 个 IPF 的 ECC 患者，术后辅助放疗、放化疗和化疗与生存结局无关。考虑到副作用和对患者生活质量的影响，应谨慎选择 PATs。
