局部晚期宫颈癌：新辅助治疗与标准放化疗——一项更新的荟萃分析

Locally Advanced Cervical Cancer: Neoadjuvant Treatment versus Standard Radio-Chemotherapy-An Updated Meta-Analysis.

作者信息

Ronsini Carlo, Solazzo Maria Cristina, Braca Eleonora, Andreoli Giada, Vastarella Maria Giovanna, Cianci Stefano, Capozzi Vito Andrea, Torella Marco, Cobellis Luigi, De Franciscis Pasquale

机构信息

Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.

Department of Woman and Child Health, IRCCS, Fondazione Policlinico Gemelli, 00136 Rome, Italy.

出版信息

Cancers (Basel). 2024 Jul 15;16(14):2542. doi: 10.3390/cancers16142542.

BACKGROUND

The treatment of choice for patients with locally advanced cervical cancer (LACC) is definitive concurrent radio chemotherapy which consists of external beam radiotherapy (EBRT) and concurrent platinum-based chemotherapy (CCRT), with the possible addition of brachytherapy (BT). However, the benefits of adjuvant surgery after neoadjuvant treatments remain a debated issue and a still open question in the literature. This meta-analysis aims to provide an updated view on the controversial topic, focusing on comparing surgery after any adjuvant treatment and standard treatment.

METHODS

Following the recommendations in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, the PubMed and Embase databases were systematically searched in April 2023 for early publications. No limitations on the country were applied. Only English articles were considered. The comparative studies containing data about disease-free survival (DFS) and/or overall survival (OS) were included in the meta-analysis.

RESULTS

The CCRT + surgery group showed a significantly better DFS than CCRT (RR 0.69 [95% CI 0.58-0.81] < 0.01) and a better OS (RR 0.70 [95% CI 0.55-0.89] < 0.01). Nine studies comparing neoadjuvant chemotherapy (NACT) plus surgery and CCRT were also enrolled. The NACT + surgery group showed a significantly better DFS than CCRT (RR 0.66 [95% CI 0.45-0.97] < 0.01) and a better OS (RR 0.56 [95% CI 0.38-0.83] < 0.01). In the sub-analysis of three randomized control trials, the surgery group documented a non-significantly better DFS and OS than CCRT (OR 1.10 [95% CI 0.67-1.80] = 0.72; I = 69% = 0.72; OR 1.09 [95% CI 0.63-1.91] = 0.75; I = 13% = 0.32).

CONCLUSION

The results provide updated findings about the efficacy of neoadjuvant treatments, indicating significantly improved DFS and OS in patients undergoing hysterectomy after CCRT or NACT compared with patients undergoing standard treatments.

背景

局部晚期宫颈癌（LACC）患者的首选治疗方法是根治性同步放化疗，包括外照射放疗（EBRT）和同步铂类化疗（CCRT），可能还会加用近距离放疗（BT）。然而，新辅助治疗后辅助手术的益处仍是一个有争议的问题，在文献中尚无定论。本荟萃分析旨在对这一有争议的话题提供最新观点，重点比较任何辅助治疗后的手术与标准治疗。

方法

按照系统评价和荟萃分析的首选报告项目（PRISMA）声明中的建议，于2023年4月对PubMed和Embase数据库进行系统检索，以查找早期发表的文献。未对国家加以限制。仅纳入英文文章。荟萃分析纳入了包含无病生存期（DFS）和/或总生存期（OS）数据的比较研究。

结果

CCRT + 手术组的DFS显著优于CCRT组（风险比[RR] 0.69 [95%置信区间（CI）0.58 - 0.81]，P < 0.01），OS也更好（RR 0.70 [95% CI 0.55 - 0.89]，P < 0.01）。还纳入了9项比较新辅助化疗（NACT）加手术与CCRT的研究。NACT + 手术组的DFS显著优于CCRT组（RR 0.66 [95% CI 0.45 - 0.97]，P < 0.01），OS也更好（RR 0.56 [95% CI 0.38 - 0.83]，P < 0.01）。在三项随机对照试验的亚组分析中，手术组的DFS和OS虽比CCRT组略好，但差异无统计学意义（优势比[OR] = 1.10 [95% CI 0.67 - 1.80]，P = 0.72；I² = 69%；OR = 1.09 [95% CI 0.63 - 1.91]，P = 0.75；I² = （此处原文有误，推测应为I²）13%）。