Wang Yang, Liu Xingyu, Liu Jing, Liu Liying, Ma Yue
Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, No.44, Xiaoheyan Road, Dadong District, Shenyang, Liaoning, 110042, People's Republic of China.
Department of General Surgery, The People's Hospital of Liaoning Province, Shenyang, Liaoning, 110067, People's Republic of China.
Arch Gynecol Obstet. 2025 Jan;311(1):123-134. doi: 10.1007/s00404-024-07896-2. Epub 2025 Jan 3.
The optimal initial management strategy for cervical cancer with lymph node metastases (LNM) remains a topic of ongoing debate. This study aimed to explore the correlation between surgery followed by postoperative radiotherapy (PORT) and definitive radiotherapy (RT), as well as their impact on the prognosis of patients with LNM.
Patients with positive lymph nodes (PLNs) in 2009 FIGO stage I-III cervical cancer were selected from SEER database. Kaplan-Meier and log-rank analysis were utilized to assess survival outcomes. Cox and Interaction analyses were employed to compare the survival benefits.
2936 patients were included in this study. Multivariate analysis revealed the choice of primary treatment significantly impacted both cancer-specific survival (CSS) and overall survival (OS), serving as an independent prognostic factor for patients with LNM. After adjusting for imbalanced variables, surgery plus PORT exhibited significant improvements in CSS and OS in the stage I-II and PLNs ≤ 5 subgroups. However, no statistically significant difference was observed between the two treatment modalities in stage III and PLNs > 5 subgroups. Through interaction analysis, it was observed that stage I-II and PLNs ≤ 5 subgroups exhibited a significant survival benefit from surgery plus PORT.
Surgery plus PORT could lead to improved outcomes for cervical cancer in patients with stage I-II or PLNs ≤ 5. However, this approach did not apply to patients with stage III or PLNs > 5. Therefore, a comprehensive assessment of LNM and local tumor spread should guide rationalized treatment modalities when managing patients presenting LNM.
宫颈癌伴淋巴结转移（LNM）的最佳初始治疗策略仍是一个持续争论的话题。本研究旨在探讨手术联合术后放疗（PORT）与根治性放疗（RT）之间的相关性，以及它们对LNM患者预后的影响。
从SEER数据库中选取2009年国际妇产科联盟（FIGO）I - III期宫颈癌伴阳性淋巴结（PLN）的患者。采用Kaplan - Meier法和对数秩检验分析评估生存结局。采用Cox模型和交互作用分析比较生存获益情况。
本研究共纳入2936例患者。多因素分析显示，初始治疗方式的选择对癌症特异性生存（CSS）和总生存（OS）均有显著影响，是LNM患者的独立预后因素。在调整不均衡变量后，手术加PORT在I - II期和PLN≤5亚组的CSS和OS方面有显著改善。然而，在III期和PLN > 5亚组中，两种治疗方式之间未观察到统计学显著差异。通过交互作用分析发现，I - II期和PLN≤5亚组从手术加PORT中获得了显著的生存获益。
手术加PORT可使I - II期或PLN≤5的宫颈癌患者预后改善。然而，这种方法不适用于III期或PLN > 5的患者。因此，在管理LNM患者时，应对LNM和局部肿瘤扩散进行综合评估，以指导合理的治疗方式。
