Department of Midwifery, Faculty of Health, Dongguan Polytechnic, Dongguan, China.
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Cancer Med. 2023 Oct;12(19):19617-19632. doi: 10.1002/cam4.6586. Epub 2023 Sep 28.
To compare the oncological outcomes of radical chemotherapy (R-CT), abdominal radical hysterectomy (ARH), and neoadjuvant chemotherapy and radical surgery (NACT) for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC cervical cancer, according to histological types: squamous cell carcinoma (SCC) and adenocarcinoma (AC)/adenosquamous cell carcinoma (ASC).
A comparison of 5-year overall survival (OS) and disease-free survival (DFS) was performed for the SCC and AC/ASC subgroups for the three initial treatments, assessed using Kaplan-Meier and Cox proportional hazards regression analysis and validated using propensity score matching (PSM).
The study included 4086 patients: R-CT, n = 1913; ARH, n = 1529; and NACT, n = 644. AC/ASC had a lower survival rate (63.7%) than SCC (73.6%) and a higher recurrence and mortality rate (36.3% and 26.4%, respectively). The 5-year OS and DFS rates were different in the SCC group for R-CT, ARH, and NACT (OS: 69.8% vs. 80.8% vs. 73.0%, p < 0.001; DFS: 66.7% vs. 70.7% vs. 56.4%, p < 0.001), also in the AC/ASC group (OS: 46.1% vs. 70.6% vs. 55.6%, p < 0.001; DFS: 42.7% vs. 64.6% vs. 40.8%, p < 0.001). As for initial treatment, survival outcomes were worse for AC/ASC treated with R-CT and ARH than for SCC (both p < 0.05), with no group differences between the two treated with NACT.
Initial treatment influences oncological prognosis for patients with FIGO 2018 stage IIIC cervical cancer. ARH is an alternative treatment for stage IIIC cervical SCC and AC/ASC, and NACT needs to be chosen with caution, moreover, R-CT for AC/ASC requires careful selection.
根据组织学类型，比较国际妇产科联合会（FIGO）2018 分期 IIIC 期宫颈癌根治性化疗（R-CT）、腹式根治性子宫切除术（ARH）和新辅助化疗加根治性手术（NACT）的肿瘤学结局：鳞癌（SCC）和腺癌（AC）/腺鳞癌（ASC）。
采用 Kaplan-Meier 和 Cox 比例风险回归分析比较 SCC 和 AC/ASC 亚组三种初始治疗的 5 年总生存率（OS）和无病生存率（DFS），并采用倾向评分匹配（PSM）进行验证。
该研究纳入 4086 例患者：R-CT 组 1913 例，ARH 组 1529 例，NACT 组 644 例。AC/ASC 的生存率（63.7%）低于 SCC（73.6%），复发率和死亡率（36.3%和 26.4%）更高。SCC 患者中 R-CT、ARH 和 NACT 的 5 年 OS 和 DFS 率不同（OS：69.8%比 80.8%比 73.0%，p<0.001；DFS：66.7%比 70.7%比 56.4%，p<0.001），AC/ASC 患者也如此（OS：46.1%比 70.6%比 55.6%，p<0.001；DFS：42.7%比 64.6%比 40.8%，p<0.001）。对于初始治疗，R-CT 和 ARH 治疗的 AC/ASC 患者的生存结局比 SCC 患者差（均 p<0.05），而接受 NACT 治疗的患者之间无组间差异。
初始治疗影响 FIGO 2018 分期 IIIC 期宫颈癌患者的肿瘤学预后。ARH 是 IIIC 期宫颈 SCC 和 AC/ASC 的替代治疗方法，NACT 需要谨慎选择，此外，R-CT 治疗 AC/ASC 需要慎重选择。
