局部晚期宫颈癌不同淋巴结状态患者的预后和治疗方案。
Prognosis and treatment regimens for patients with different lymph node statuses in locally advanced cervical cancer.
机构信息
School of Medicine, Nankai University, Tianjin, 300071, China; Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China.
Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China.
出版信息
Eur J Surg Oncol. 2024 Nov;50(11):108522. doi: 10.1016/j.ejso.2024.108522. Epub 2024 Jun 29.
OBJECTIVE
The survival outcomes of Stage IIIC1 in FIGO 2018 showed significant heterogeneity and it seems unreasonable to administer a uniform treatment regimen for Stage IIIC1 patients. This study aimed to assess the survival outcomes among patients with locally advanced cervical cancer based on various lymph node statuses, T-stage classifications, and treatment modalities.
METHODS
This is a population-based cohort study utilizing the Surveillance, Epidemiology, and End Results Program from 2004 to 2018. Propensity score-based inverse probability of treatment weighting was used to achieve covariate balance. Women with locally advanced cervical cancer on different lymph node statuses who underwent radical hysterectomy + pelvic lymphadenectomy + chemoradiotherapy, chemoradiotherapy, or radiotherapy alone were examined. Trends, patient characteristics, and survival outcomes were compared across different treatment regimens.
RESULTS
Among 8777 patients analyzed, patients with early T-stage and married were identified as independent protective factors for cancer-specific survival regardless of lymph node status. The survival outcomes ranked in descending order as follows: T1N0>T2N0>T1N1 = T2N1>T3N0>T3N1. Therefore, the FIGO Stage IIIC1 was re-stratified into IIC (T1N1+T2N1) and IIIC1(T3N1). Patients who underwent radical hysterectomy combined with adjuvant therapy exhibited superior 5-year cancer-specific survival rates compared to those treated with chemoradiotherapy among IB3, IIA2, and IIC. The therapeutic efficacy of chemoradiotherapy surpassed that of radiotherapy alone in IIIA, IIIB, IIIC1(T3N1), and IVA patients.
CONCLUSION
Restratification of Stage IIIC1 based on T-stage effectively discerns patients with divergent prognoses. Radical surgery + chemoradiotherapy is significantly associated with improved survival in early T-stage, regardless of lymph node status in locally advanced cervical cancer.
目的
FIGO 2018 分期的 IIIC1 期患者的生存结局存在显著异质性，对 IIIC1 期患者采用统一的治疗方案似乎并不合理。本研究旨在评估不同淋巴结状态、T 分期分类和治疗方式下局部晚期宫颈癌患者的生存结局。
方法
这是一项基于人群的队列研究，使用了 2004 年至 2018 年期间的监测、流行病学和最终结果计划（Surveillance, Epidemiology, and End Results Program）。采用倾向评分逆概率治疗加权法（propensity score-based inverse probability of treatment weighting）实现协变量平衡。对不同淋巴结状态下接受根治性子宫切除术+盆腔淋巴结切除术+放化疗、放化疗或单纯放疗的局部晚期宫颈癌患者进行检查。比较了不同治疗方案之间的趋势、患者特征和生存结局。
结果
在分析的 8777 名患者中，早期 T 分期和已婚被确定为无论淋巴结状态如何，癌症特异性生存的独立保护因素。生存结局依次为 T1N0>T2N0>T1N1=T2N1>T3N0>T3N1。因此，FIGO IIIC1 期被重新分为 IIC（T1N1+T2N1）和 IIIC1（T3N1）期。在 IB3、IIA2 和 IIC 期患者中，接受根治性子宫切除术联合辅助治疗的患者与接受放化疗的患者相比，5 年癌症特异性生存率更高。在 IIIA、IIIB、IIIC1（T3N1）和 IVA 期患者中，放化疗的疗效优于单纯放疗。
结论
基于 T 分期对 IIIC1 期进行重新分期，可以有效地区分预后不同的患者。在局部晚期宫颈癌中，无论淋巴结状态如何，早期 T 分期患者接受根治性手术+放化疗治疗与生存改善显著相关。
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