Werner-Wasik M, Schmid C H, Bornstein L, Ball H G, Smith D M, Madoc-Jones H
New England Medical Center Hospitals, Boston, MA, USA.
Int J Radiat Oncol Biol Phys. 1995 Jul 30;32(5):1309-17. doi: 10.1016/0360-3016(94)00613-P.
The effects of tumor size, parametrial involvement, and other variables on treatment outcome for patients with Federation Internationale de Gynecologie et d'Obstetrique (FIGO) Stage I or II cervical carcinoma, as well as treatment complications, were analyzed retrospectively.
Records of 125 patients with FIGO Stage I or II carcinoma of the uterine cervix selected for curative radiotherapy between January 1980 and December 1990 were reviewed. Twelve patients (9.9%) underwent adjuvant extrafascial hysterectomy and 8 patients (6.4%) received chemotherapy. Median age was 55 years. Median follow-up time was 40 months, and minimum follow-up time was 24 months. The data were analyzed for site of first relapse, survival, overall incidence of complications, and incidence of grade 4 complications.
The overall 5-year survival was: Stage IA: 100%, Stage IB: 72%, Stage IIA: 90%, and Stage IIB: 72%. The 5-year survival with no evidence of disease (NED) was: Stage IA: 100%, Stage IB: 67%, Stage IIA: 90%, and Stage IIB: 50%. Patients with bulky (> 5 cm) tumors had a shorter overall and NED survival than patients with nonbulky tumors (53% vs. 83%; p = 0.0008 and 44% vs. 78%; p = 0.0001, respectively). Thirty-nine tumor recurrences (39 out of 125 = 31%) occurred and were scored as local (23 out of 125 = 18.3%), if initial failure had a local component, or distant (16 out of 125 = 12.7%), if initial failure was distant only. Patients with bulky (more than 5 cm) tumors (32 out of 125) were more likely to experience a recurrence (18 out of 32 = 56%) than patients with nonbulky tumors (21 out of 93 = 22%; p = 0.0004). The initial site of recurrence was more likely to be local for bulky tumors (14 out of 18 = 78%) than for nonbulky tumors (9 out of 21 = 43%; p = 0.03). The probability of a recurrence increased with the number of involved parametria (none: 20 out of 78 = 25%; one: 12 out of 34 = 35%; two: 7 out of 13 = 54%; p = 0.04 for linear trend), as did the probability that the initial failure was distant rather than local (none: 4 out of 20 = 20%; one: 7 out of 12 = 58%; two: 5 out of 7 = 71%; p = 0.01 for linear trend). Positive lymph nodes, vessel invasion, and low hemoglobin level all correlated with an increased risk of a recurrence (RR 2.41, p = 0.004; RR 2.20, p = 0.01; OR 2.02, p = 0.01, respectively). There were 46 complications among 37 (29%) patients. The incidence of grade 4 complications was 8.8% (11 out of 125). History of pelvic surgery and bulky tumor were significant predictors of a grade 4 complication (p < 0.0001 and 0.021, respectively). Also, a dose rate to point A of > 0.6 Gy/h increased the chance of a grade 4 complication (p = 0.007).
For patients with FIGO Stage I or II cervical carcinoma, tumor size was more predictive of local recurrence than was overall stage, and the extent of parametrial involvement was strongly predictive of distant recurrence, as was the stage. These findings suggest that tumor size and extent of parametrial involvement should be incorporated into the staging system. Patients with bulky tumors had a shorter survival and were more likely to experience a grade 4 toxicity of therapy. Dose rate to point A of > 0.6 Gy/h was associated with the increased risk of grade 4 complications.
回顾性分析肿瘤大小、宫旁组织受累情况及其他变量对国际妇产科联盟（FIGO）Ⅰ期或Ⅱ期宫颈癌患者治疗结局以及治疗并发症的影响。
回顾了1980年1月至1990年12月期间选择接受根治性放疗的125例FIGOⅠ期或Ⅱ期子宫颈癌患者的记录。12例患者（9.9%）接受了辅助筋膜外子宫切除术，8例患者（6.4%）接受了化疗。中位年龄为55岁。中位随访时间为40个月，最短随访时间为24个月。分析了首次复发部位、生存率、并发症总发生率和4级并发症发生率的数据。
总体5年生存率为：ⅠA期：100%，ⅠB期：72%，ⅡA期：90%，ⅡB期：72%。无疾病证据（NED）的5年生存率为：ⅠA期：100%，ⅠB期：67%，ⅡA期：90%，ⅡB期：50%。肿瘤体积较大（>5 cm）的患者总体生存率和无疾病生存率均低于肿瘤体积较小的患者（分别为53%对83%；p = 0.0008和44%对78%；p = 0.0001）。39例（125例中的39例 = 31%）出现肿瘤复发，若初始失败有局部成分则计为局部复发（125例中的23例 = 18.3%），若初始失败仅为远处转移则计为远处复发（125例中的16例 = 12.7%）。肿瘤体积较大（超过5 cm）的患者（125例中的32例）比肿瘤体积较小的患者（93例中的21例 = 22%）更易复发（32例中的18例 = 56%；p = 0.0004）。与肿瘤体积较小的患者相比，肿瘤体积较大的患者复发的初始部位更可能是局部（18例中的14例 = 78%对21例中的9例 = 43%；p = 0.03）。复发概率随受累宫旁组织数量的增加而增加（无：78例中的20例 = 25%；1个：34例中的12例 = 35%；2个：13例中的7例 = 54%；线性趋势p = 0.04），初始失败为远处而非局部的概率也如此（无：20例中的4例 = 20%；1个：12例中的7例 = 58%；2个：7例中的5例 = 71%；线性趋势p = 0.01）。阳性淋巴结、血管侵犯和低血红蛋白水平均与复发风险增加相关（相对风险分别为2.41，p = 0.004；相对风险2.20，p = 0.01；比值比2.02，p = 0.
