Hunsberger Kyra S, Tewari Krishnansu S, Monk Bradley J, Chase Dana M
The University of Arizona, College of Medicine, Phoenix, United States of America.
Division of Gynecologic Oncology, University of California, Irvine, United States of America.
Gynecol Oncol. 2024 Dec;191:259-264. doi: 10.1016/j.ygyno.2024.10.023. Epub 2024 Oct 30.
Our aim was to perform a systematic review and meta-analysis evaluating the efficacy of standard treatment for stage IVB cervical cancer.
Databases were searched for Phase III trials evaluating stage IVB CC patients according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Systematic review included Phase III trials evaluating first-line treatment of stage IVB cervical cancer (CC). A meta-analysis was pursued for Phase III trials establishing standard of care treatment that included independent analyses of stage IVB, persistent, and recurrent CC.
For the systematic review, 8 studies met inclusion criteria, with a total of 3,161 CC patients analyzed. Of these studies, three met criteria and included suitable data for meta-analysis - GOG 240, KEYNOTE-826, and BEATcc. Of the 1,479 women included in the meta-analysis, 289 (19.5 %) had stage IVB and 1,190 (80.5 %) had persistent or recurrent CC. HR of OS was 0.64 (95 % confidence interval (CI): 0.55-0.75) and 0.85 (95 % CI: 0.64-1.14) for persistent/recurrent and stage IVB CC, respectively. In the test of group differences, p-value was insignificant at 0.098.
While trials have assessed outcomes in stage IVB, persistent, and recurrent CC, new treatments demonstrate poorer PFS and OS for stage IVB compared to persistent and recurrent CC. The exact benefit for current standard of care for stage IVB CC could be better defined. Given that stage IVB CC has a different clinical course and treatment history compared to persistent and recurrent disease, stage IVB CC should be analyzed independently in future clinical trials.
我们的目的是进行一项系统评价和荟萃分析，以评估IVB期宫颈癌标准治疗的疗效。
根据系统评价和荟萃分析的首选报告项目（PRISMA）2020指南，检索数据库中评估IVB期宫颈癌患者的III期试验。系统评价包括评估IVB期宫颈癌一线治疗的III期试验。对确立标准治疗方案的III期试验进行荟萃分析，其中包括对IVB期、持续性和复发性宫颈癌的独立分析。
在系统评价中，8项研究符合纳入标准，共分析了3161例宫颈癌患者。在这些研究中，3项符合标准并包含适用于荟萃分析的数据——GOG 240、KEYNOTE-826和BEATcc。在荟萃分析纳入的1479名女性中，289名（19.5%）为IVB期，1190名（80.5%）为持续性或复发性宫颈癌。持续性/复发性和IVB期宫颈癌的总生存期（OS）风险比（HR）分别为0.64（95%置信区间（CI）：0.55 - 0.75）和0.85（95%CI：0.64 - 1.14）。在组间差异检验中，p值为0.098，无统计学意义。
虽然已有试验评估了IVB期、持续性和复发性宫颈癌的结局，但与持续性和复发性宫颈癌相比，新治疗方法在IVB期的无进展生存期（PFS）和总生存期较差。IVB期宫颈癌当前标准治疗的确切获益尚需进一步明确。鉴于IVB期宫颈癌与持续性和复发性疾病相比具有不同的临床病程和治疗史，未来临床试验中应独立分析IVB期宫颈癌。
