Huang Kuan-Ching, Cheng Jen-Yu, Chen Chung-Shih, Wang Chong-Jong, Huang Eng-Yen
Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan.
Department of Radiation Oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City 801, Taiwan.
Cancers (Basel). 2025 Apr 26;17(9):1449. doi: 10.3390/cancers17091449.
In patients undergoing a radical hysterectomy, uterine corpus invasion worsens cervical cancer prognosis. However, the prognostic role of the invasion in locally advanced stages remains elusive. Due to the inadequacy of typical corpus biopsies, corpus invasion is diagnosed using magnetic resonance imaging (MRI). In this study, we investigated the prognostic role of MRI-detected uterine corpus invasion in patients undergoing radiotherapy for cervical cancer.
This retrospective analysis involved 259 patients without extrapelvic metastases, diagnosed with FIGO 2009 stages IB-IVA cervical carcinoma from January 2011 to December 2020. The corpus invasion extent was classified as exocervical-confined (group 1), endocervical (group 2), or uterine corpus invasion (group 3). The rates of overall survival, cancer-specific survival, locoregional recurrence, para-aortic lymph node recurrence, and extrapelvic metastases after pelvic radiotherapy were analyzed. Kaplan-Meier and Cox regression analyses were used to determine recurrence-associated risks. Optimal risk stratification was predicted using a receiver operating characteristic curve with the area under the curve.
Groups 1, 2, and 3 included 66.0%, 18.9%, and 15.1% of patients, respectively. The 5-year para-aortic lymph node recurrence rates were 6.3%, 17.2%, and 34.2% ( < 0.001). Uterine corpus invasion was an independent factor for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence. Including uterine corpus invasion in the risk stratification led to higher areas under the curve for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence than using single parameters.
In cervical cancer, following pelvic radiotherapy, uterine corpus invasion is a significant prognostic factor. More-aggressive treatments such as extended-field radiotherapy, adjuvant chemotherapy, and immune checkpoint inhibitors as an alternative to standard pelvic radiotherapy with concurrent chemotherapy may be considered in these patients.
在接受根治性子宫切除术的患者中，子宫体侵犯会使宫颈癌预后恶化。然而，在局部晚期阶段，这种侵犯的预后作用仍不明确。由于典型的子宫体活检不充分，子宫体侵犯通过磁共振成像（MRI）进行诊断。在本研究中，我们调查了MRI检测到的子宫体侵犯在接受宫颈癌放疗患者中的预后作用。
这项回顾性分析纳入了259例无盆腔外转移的患者，这些患者在2011年1月至2020年12月期间被诊断为国际妇产科联盟（FIGO）2009分期的IB-IVA期宫颈癌。子宫体侵犯程度分为宫颈外局限（第1组）、宫颈内（第2组）或子宫体侵犯（第3组）。分析了盆腔放疗后总生存、癌症特异性生存、局部区域复发、腹主动脉旁淋巴结复发和盆腔外转移的发生率。采用Kaplan-Meier法和Cox回归分析来确定复发相关风险。使用曲线下面积的受试者工作特征曲线预测最佳风险分层。
第1组、第2组和第3组分别包括66.0%、18.9%和15.1%的患者。5年腹主动脉旁淋巴结复发率分别为6.3%、17.2%和34.2%（<0.001）。子宫体侵犯是总生存、癌症特异性生存、局部区域复发、盆腔外转移和腹主动脉旁淋巴结复发的独立因素。与使用单一参数相比，将子宫体侵犯纳入风险分层导致总生存、癌症特异性生存、局部区域复发、盆腔外转移和腹主动脉旁淋巴结复发的曲线下面积更高。
在宫颈癌中，盆腔放疗后，子宫体侵犯是一个重要的预后因素。对于这些患者，可考虑采用更积极的治疗方法，如扩大野放疗、辅助化疗和免疫检查点抑制剂，以替代标准的盆腔放疗联合同步化疗。
