Niu Yuna, Du Chengchao, Zhou Yeqin, Zhang Miao, Guo Qi, Zhou Honggui
Department of Gynecology and Obstetrics, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
North Sichuan Medical College, Nanchong, China.
Front Oncol. 2025 Feb 28;15:1511748. doi: 10.3389/fonc.2025.1511748. eCollection 2025.
To compare the long-term efficacy and adverse effects of preoperative brachytherapy combined with radical surgery versus concurrent chemoradiotherapy (CCRT) in patients with locally advanced cervical cancer (LACC).
This retrospective study analyzed 161 patients with LACC treated at the Affiliated Hospital of North Sichuan Medical College between January 2015 and December 2020. Of these, 76 patients underwent preoperative brachytherapy combined with radical surgery (study group), while 85 received CCRT (control group). After propensity score matching (PSM) to minimize confounding, 124 patients (62 per group) were included in the analysis. Survival outcomes and prognostic factors were evaluated using Kaplan-Meier survival analysis and Cox regression models. Adverse effects of treatment were compared between the groups.
After PSM, the 5-year progression-free survival (PFS) rate in the study group was significantly higher than that in the control group (81.2% vs. 62.7%, <0.05). There was no significant between-group difference regarding the 5-year overall survival (OS) rate (81.4% vs. 74.9%, =0.41). Multivariate analysis identified treatment modality (preoperative brachytherapy combined with radical surgery vs. CCRT) as an independent prognostic factor for PFS (HR: 0.458, 95% CI 0.221-0.945, =0.035). The study group had significantly lower rates of grade 2 acute radiation enteritis, grade 3-4 leukopenia, and anemia compared to the control group (<0.05), with no significant differences observed in other adverse effects (>0.05).
Preoperative brachytherapy combined with radical surgery may help improve the PFS of patients with LACC, with fewer adverse effects, making it a potentially viable treatment option for these patients.
比较术前近距离放疗联合根治性手术与同期放化疗（CCRT）治疗局部晚期宫颈癌（LACC）患者的长期疗效和不良反应。
这项回顾性研究分析了2015年1月至2020年12月在川北医学院附属医院接受治疗的161例LACC患者。其中，76例患者接受术前近距离放疗联合根治性手术（研究组），85例接受CCRT（对照组）。在进行倾向评分匹配（PSM）以尽量减少混杂因素后，124例患者（每组62例）纳入分析。使用Kaplan-Meier生存分析和Cox回归模型评估生存结局和预后因素。比较两组治疗的不良反应。
PSM后，研究组的5年无进展生存率（PFS）显著高于对照组（81.2%对62.7%，<0.05）。两组的5年总生存率（OS）无显著差异（81.4%对74.9%，=0.41）。多因素分析确定治疗方式（术前近距离放疗联合根治性手术与CCRT）是PFS的独立预后因素（HR：0.458，95%CI 0.221-0.945，=0.035）。与对照组相比，研究组2级急性放射性肠炎、3-4级白细胞减少和贫血的发生率显著较低（<0.05），其他不良反应无显著差异（>0.05）。
术前近距离放疗联合根治性手术可能有助于提高LACC患者的PFS，且不良反应较少，使其成为这些患者潜在可行的治疗选择。
