Thakur Purnima, Singh Kaalindi, Kumar Vineet, Gupta Manish, Thakur Shabnam
Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, IND.
Department of Radiotherapy, Shri Lal Bahadur Shastri Government Medical College and Hospital, Mandi, IND.
Cureus. 2024 Oct 19;16(10):e71824. doi: 10.7759/cureus.71824. eCollection 2024 Oct.
Cervical cancer is the second most common malignancy among Indian women after breast cancer. This study was undertaken to determine the pattern of care, long-term survival outcomes, and prognostic factors for cervical cancer patients treated at a tertiary care cancer centre in North India.
Ten-year data was retrieved for 435 stage I-IVA carcinoma cervix patients treated between 2009 and 2019. A sociodemographic profile of the patients, treatment methods, and conditions at follow-up were obtained.
Data was analyzed using Stata 15.1 (StataCorp LLC, College Station, Texas, United States). Qualitative variables were shown as frequencies/percentages, and quantitative as means/standard deviations. Key endpoints were overall, disease-free, and locoregional survival. Kaplan-Meier curves represented survival. Cox regression models assessed parameter influence. Statistical significance was set at p < 0.05, with hazard ratios and 95% confidence intervals reported.
Fourteen (3.2%) patients underwent surgery; of the patients who underwent surgery, except two patients who underwent surgery alone, all patients received external beam radiotherapy (EBRT) followed by EBRT (26.4%) or brachytherapy boost (72.4%). Seventy-one per cent of patients received more than four cycles of concurrent chemotherapy. The median overall survival (OS) was 42.04 (0.25-171) months, and the median disease-free survival (DFS) was 32.85 months (1-171) months. The median overall survival was 58.76%, and the two-year and five-year overall survival percentages were 81.34% and 64.52%, respectively. The median time to locoregional relapse and distant metastasis was 35 (1-171) and 37.6 (1-171) months, respectively. Bilateral parametrial involvement was a predictor of poor OS (p = 0.039), DFS (p = 0.039), and locoregional failure-free survival (LFFS) (p = 0.020). Age less than 50 years was a predictor of worse DFS (p = 0.034) and LFFS (p = 0.005), while paraaortic nodal involvement was a predictor of worse DFS (p = 0.045). Grade III tumours neared numerical significance (p = 0.051) for worse distant metastases-free survival.
Bilateral parametrial involvement was the most significant factor for OS, DFS, and LFFS. Paraaortic nodal involvement predicted poor DFS and young age was associated with poor DFS and LFFS.
宫颈癌是印度女性中仅次于乳腺癌的第二大常见恶性肿瘤。本研究旨在确定印度北部一家三级癌症中心治疗的宫颈癌患者的治疗模式、长期生存结果和预后因素。
检索了2009年至2019年间治疗的435例I-IVA期宫颈癌患者的十年数据。获取了患者的社会人口统计学资料、治疗方法和随访情况。
使用Stata 15.1（美国德克萨斯州大学站StataCorp有限责任公司）进行数据分析。定性变量以频率/百分比表示，定量变量以均值/标准差表示。主要终点为总生存、无病生存和局部区域生存。Kaplan-Meier曲线表示生存情况。Cox回归模型评估参数影响。设定统计学显著性为p<0.05，并报告风险比和95%置信区间。
14例（3.2%）患者接受了手术；在接受手术的患者中，除2例仅接受手术的患者外，所有患者均接受了外照射放疗（EBRT），随后接受EBRT（26.4%）或近距离放疗加量（72.4%）。71%的患者接受了超过四个周期的同步化疗。总生存（OS）中位数为42.04（0.25-171）个月，无病生存（DFS）中位数为32.85个月（1-171）个月。总生存中位数为58.76%，两年和五年总生存百分比分别为81.34%和64.52%。局部区域复发和远处转移的中位时间分别为35（1-171）个月和37.6（1-171）个月。双侧宫旁组织受累是OS（p=0.039）、DFS（p=0.039）和局部区域无复发生存（LFFS）（p=0.020）不良的预测因素。年龄小于50岁是DFS（p=0.034）和LFFS（p=0.005）较差的预测因素，而腹主动脉旁淋巴结受累是DFS较差的预测因素（p=0.045）。III级肿瘤在远处无转移生存较差方面接近统计学显著性（p=0.051）。
双侧宫旁组织受累是OS、DFS和LFFS的最显著因素。腹主动脉旁淋巴结受累预示DFS不良，年轻与DFS和LFFS不良相关。
