Agustí Núria, Viveros-Carreño David, Wu Chi-Fang, Wilke Roni Nitecki, Kanbergs Alexa, Barajas Karla, Zamorano Abigail S, Pareja René, Melamed Alexander, Rauh-Hain J Alejandro
The University of Texas MD Anderson Cancer Center, Houston.
Unidad Ginecología Oncológica, Grupo de Investigación GIGA, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo-CTIC, Bogotá, Colombia.
JAMA Oncol. 2025 May 1;11(5):511-518. doi: 10.1001/jamaoncol.2025.0146.
Optimal adjuvant treatment for patients with intermediate-risk cervical cancer remains controversial, and the benefit of adding chemotherapy to radiotherapy in this population is uncertain.
To evaluate whether adjuvant chemoradiotherapy is associated with improved overall survival compared with radiotherapy alone in patients with intermediate-risk cervical cancer. Secondary objectives included identifying clinical factors associated with the use of chemoradiotherapy.
DESIGN, SETTING, AND PARTICIPANTS: A cohort study was conducted at Commission on Cancer-accredited centers across the US using prospectively collected data from the National Cancer Database that focused on patients with a diagnosis of 2018 International Federation of Gynecology and Obstetrics stage IB cervical carcinoma (squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma) of intermediate risk who were undergoing adjuvant radiotherapy treatment after radical hysterectomy from January 2010 through December 2020. Missing variables were multiple imputed, and propensity score matching (1:1) was performed to balance baseline characteristics. A Kaplan-Meier analysis and proportional hazard models were used to compare the hazard of death between the groups.
Adjuvant radiotherapy alone vs concurrent chemoradiotherapy.
The primary outcome was time to death or last follow-up.
A total of 1116 patients (mean [SD] age, 47 [12] years) were identified, of whom 486 (43.5%) received concurrent chemoradiotherapy. Chemotherapy was administered more frequently among those with adenocarcinoma or adenosquamous histology compared with squamous cell carcinoma (risk ratio [RR], 1.26; 95% CI, 1.10-1.44) and those with tumors larger than 4 cm (compared with tumors measuring 2-4 cm; RR, 1.31; 95% CI, 1.14-1.51). Propensity score matching yielded a cohort of 868 patients with balanced covariates. Patients who received chemoradiotherapy had similar overall survival (5- year survival, 87%) as those who received radiotherapy alone (5-year survival, 87%; hazard ratio, 0.85; 95% CI, 0.59-1.23; P = .38). There were no significant differences in survival associated with chemotherapy receipt among subgroups defined by tumor size, histology, presence of lymphovascular space invasion, surgical approach, or receipt of adjuvant brachytherapy.
The results of this cohort study suggest that adding chemotherapy to radiotherapy was not associated with improved overall survival for patients with intermediate-risk cervical cancer.
中危型宫颈癌患者的最佳辅助治疗仍存在争议，在这一人群中放疗联合化疗的获益尚不确定。
评估在中危型宫颈癌患者中，与单纯放疗相比，辅助放化疗是否能改善总生存期。次要目的包括确定与放化疗使用相关的临床因素。
设计、地点和参与者：在美国癌症委员会认可的中心进行了一项队列研究，使用从国家癌症数据库前瞻性收集的数据，该数据库聚焦于2010年1月至2020年12月期间接受根治性子宫切除术后接受辅助放疗的2018年国际妇产科联盟IB期宫颈癌（鳞状细胞癌、腺鳞癌或腺癌）中危型诊断患者。对缺失变量进行多重填补，并进行倾向评分匹配（1:1）以平衡基线特征。使用Kaplan-Meier分析和比例风险模型比较两组之间的死亡风险。
单纯辅助放疗与同步放化疗。
主要结局是至死亡或最后一次随访的时间。
共识别出1116例患者（平均[标准差]年龄，47[12]岁），其中486例（43.5%）接受了同步放化疗。与鳞状细胞癌相比，腺癌或腺鳞癌组织学类型的患者化疗使用频率更高（风险比[RR]，1.26；95%置信区间，1.10-1.44），肿瘤大于4 cm的患者（与2-4 cm的肿瘤相比；RR，1.31；95%置信区间，1.14-1.51）。倾向评分匹配产生了一组868例协变量平衡的患者。接受放化疗的患者的总生存期（5年生存率，87%）与单纯接受放疗的患者相似（5年生存率，87%；风险比，0.85；95%置信区间，0.59-1.23；P = 0.38）。在按肿瘤大小、组织学类型、是否存在脉管间隙浸润、手术方式或辅助近距离放疗划分的亚组中，化疗的生存获益无显著差异。
这项队列研究的结果表明，在中危型宫颈癌患者中，放疗联合化疗并不能改善总生存期。
