da Silva Pedro Henrique Costa Matos, Molino Gabriela Oliveira Gonçalves, Dias Maírla Marina Ferreira, Pereira Ana Gabriela Alves, Pimenta Nicole Dos Santos, Cavalcante Deivyd Vieira Silva, de Farias Santos Ana Clara Felix, Ferreira Sarah Hasimyan, da Silva Santos Rodrigo, da Silva Reis Angela Adamski
Department of Obstetrics and Gynecology, Federal University of Goiás, Goiânia 74690-900, GO, Brazil.
Gynecologic Oncology Service, Federal District Base Hospital, Brasília 70040-010, DF, Brazil.
J Clin Med. 2025 Jun 5;14(11):4002. doi: 10.3390/jcm14114002.
The risk of recurrence of early-stage cervical cancer (CC) is associated with prognostic factors such as tumor size, lymphovascular space invasion (LVSI), and deep stromal invasion (DSI). However, the adjuvant pelvic radiotherapy (RT) following surgery to reduce the risk of recurrence in "intermediate risk" remains controversial. This study aims to evaluate the role of adjuvant RT in the recurrence and identify prognostic factors. A systematic search of PubMed, Embase, and Cochrane databases was performed to identify studies comparing adjuvant RT versus no adjuvant treatment in early-stage CC patients with intermediate-risk factors defined by GOG-92 criteria. Outcomes were recurrence, local recurrence, death, 5-year overall survival (5y-OS), and 5-year disease-free survival (5y-DFS). Tumor size ≥ 4 cm, LVSI, and DSI were also evaluated as prognostic factors for recurrence. Statistical analysis was performed using Review Manager 7.2.0. Heterogeneity was assessed with I statistics. A total of 1504 patients from nine studies were included; only one study was a randomized controlled trial, while the others were retrospective cohorts. Adjuvant RT was used to treat 781 patients (52%). Median follow-up ranged from 48 to 120 months. Recurrence (OR 0.75; 95% CI 0.38-1.46; = 0.39), local recurrence (OR 0.73; 95% CI 0.44-1.20; = 0.22), death (OR 0.97; 95% CI 0.52-1.80; = 0.91), 5y-OS (OR 1.22; 95% CI 0.36-4.18; = 0.75), and 5y-DFS (OR 0.78; 95% CI 0.42-1.43 = 0.42) revealed no statistically significant differences between adjuvant RT and observation groups. TS ≥ 4 cm was an independent prognostic risk factor for recurrence (HR 1.83; 95% CI 1.12-2.97; = 0.02). Our findings suggest that adjuvant RT does not reduce recurrence risk in early-stage cervical cancer. Consider TS ≥ 4 cm as a significant prognostic factor for recurrence. Adjuvant RT in intermediate-risk patients should be considered with caution due the lack of significant improvement in recurrence until the CERVANTES and GOG-0263 trial results become available.
早期宫颈癌（CC）的复发风险与肿瘤大小、脉管间隙浸润（LVSI）和深层间质浸润（DSI）等预后因素相关。然而，手术后辅助盆腔放疗（RT）以降低“中危”患者的复发风险仍存在争议。本研究旨在评估辅助放疗在复发中的作用并确定预后因素。对PubMed、Embase和Cochrane数据库进行了系统检索，以识别比较辅助放疗与未进行辅助治疗的、符合GOG-92标准定义的具有中危因素的早期CC患者的研究。结局指标为复发、局部复发、死亡、5年总生存率（5y-OS）和5年无病生存率（5y-DFS）。肿瘤大小≥4 cm、LVSI和DSI也被评估为复发的预后因素。使用Review Manager 7.2.0进行统计分析。用I统计量评估异质性。纳入了来自9项研究的1504例患者；只有1项研究是随机对照试验，其他为回顾性队列研究。781例患者（52%）接受了辅助放疗。中位随访时间为48至120个月。复发（OR 0.75；95%CI 0.38-1.46；P = 0.39）、局部复发（OR 0.73；95%CI 0.44-1.20；P = 0.22）、死亡（OR 0.97；95%CI 0.52-1.80；P = 0.91）、5y-OS（OR 1.22；95%CI 0.36-4.18；P = 0.75）和5y-DFS（OR 0.78；95%CI 0.42-1.43；P = 0.42）显示辅助放疗组与观察组之间无统计学显著差异。肿瘤大小≥4 cm是复发的独立预后危险因素（HR 1.83；95%CI 1.12-2.97；P = 0.02）。我们的研究结果表明，辅助放疗并不能降低早期宫颈癌的复发风险。将肿瘤大小≥4 cm视为复发的重要预后因素。由于在CERVANTES和GOG-0263试验结果出来之前，复发情况没有显著改善，对于中危患者的辅助放疗应谨慎考虑。
