Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
J Gynecol Oncol. 2024 Nov;35(6):e113. doi: 10.3802/jgo.2024.35.e113. Epub 2024 Jul 30.
In this multicenter retrospective cohort study of 99 patients who underwent salvage hysterectomy for residual disease in the uterine cervix following the completion of definitive radiotherapy for cervical cancer across 25 Japan Clinical Oncology Group-affiliated centers from 2005-2014, (i) time duration from the completion of definitive radiotherapy to the diagnosis of residual disease in the uterine cervix, (ii) salvage hysterectomy surgical margin status, and (iii) extent of residual disease, were independently associated with progression-free survival (PFS). Specifically, (i) time duration to identify residual disease of >62 days was associated with decreased PFS compared to ≤62 days (4-year rates 21.8% vs. 55.0%, adjusted-hazard ratio [aHR]=2.69, 95% confidence interval [CI]=1.55-4.67); (ii) presence of tumor in the surgical margin of hysterectomy specimen was associated with 4 times increased risk of disease progression compared to tumor-free surgical margin (4-year PFS rates 0% vs. 45.3%, aHR=4.27, 95% CI=2.20-8.29); and (iii) hazards of disease progression was 4.5-fold increased when the residual disease extended beyond the uterine cervix compared to residual disease within the uterine cervix only (4-year PFS rates 11.1% vs. 50.6%, aHR=4.54, 95% CI=2.60-7.95). In the absence of these 3 prognostic factors, 4-year PFS rate reached nearly 80% (78.6%, SAL-HYS criteria). In sum, these data suggested that early detection of persistent, residual disease following definitive radiotherapy for cervical cancer may be the key to improve survival if salvage hysterectomy is considered as a tailored treatment option. Ideal surgical candidate would be uterine cervix-contained disease and assurance of adequate tumor-free surgical margin.
在这项多中心回顾性队列研究中，纳入了 99 例患者，这些患者均于 2005 年至 2014 年间在 25 家日本癌症临床研究组附属中心接受根治性放疗后，出现宫颈癌残留病灶，并接受挽救性子宫切除术。研究分析了与无进展生存期（progression-free survival，PFS）相关的因素，包括：（i）根治性放疗完成至宫颈癌残留病灶诊断的时间间隔；（ii）挽救性子宫切除术的手术切缘状态；（iii）残留病灶的范围。具体而言：（i）与≤62 天相比，>62 天发现残留病灶与 PFS 降低相关（4 年 PFS 率分别为 21.8%和 55.0%，调整后的风险比[aHR]为 2.69，95%置信区间[CI]为 1.55-4.67）；（ii）子宫切除术标本切缘存在肿瘤与肿瘤无切缘相比，疾病进展的风险增加 4 倍（4 年 PFS 率分别为 0%和 45.3%，aHR 为 4.27，95% CI 为 2.20-8.29）；（iii）与仅宫颈内残留病灶相比，宫颈外残留病灶的疾病进展风险增加 4.5 倍（4 年 PFS 率分别为 11.1%和 50.6%，aHR 为 4.54，95% CI 为 2.60-7.95）。如果不考虑这 3 个预后因素，4 年 PFS 率接近 80%（78.6%，SAL-HYS 标准）。总之，这些数据表明，如果考虑将挽救性子宫切除术作为一种个体化治疗方案，早期发现宫颈癌根治性放疗后持续存在的残留病灶可能是改善生存的关键。理想的手术候选者是宫颈内病变，并且保证有足够的无肿瘤切缘。
