FIGO 2018子宫颈癌新分期ⅠB3期治疗策略探讨  

Investigation of treatment strategy for FIGO 2018 stageⅠB3 cervical cancer

作　　者：张文玲 王倩青[2] 苏桂栋[1] 王莉[3] 詹雪梅[4] 郭建新 倪妍 林丽红[7] 王绍光[8] 梁国强 郎景和 刘萍[1] 陈春林[1] ZHANG Wen-ling;WANG Qianqing;SU Gui-dong;WANG Li;ZHAN Xue-mei;GUO Jian-xin;NI Yan;LIN Li-hong;WANG Shao-guang;LIANG Guoqiang;LANG Jing-he;LIU Ping;CHEN Chun-lin(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;不详)

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]新乡市中心医院,河南新乡453000 [3]河南省肿瘤医院妇科,河南郑州450008 [4]江门市中心医院妇科,广东江门529030 [5]中国人民解放军陆军特色医学中心(大坪医院),重庆400042 [6]运城市中心医院妇科,山西运城044000 [7]安阳市肿瘤医院妇瘤科,河南安阳455000 [8]烟台毓璜顶医院,山东烟台264000 [9]中国医学科学院北京协和医院妇产科,北京100730

出　　处：《中国实用妇科与产科杂志》2021年第9期954-958,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：十二五国家科技支撑计划(2014BAI05B03);广州市科技计划(158100075);广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2016ZD019)。

摘　　要：目的从肿瘤学结局角度对比FIGO 2018子宫颈癌新分期ⅠB3期开腹广泛性子宫切除手术(ARH)、新辅助化疗后开腹手术(NACT)、根治性放化疗(R-CT)3种治疗方式的差异,探讨ⅠB3期子宫颈癌适宜治疗策略。方法基于中国子宫颈癌临床诊疗项目数据库,纳入FIGO 2018子宫颈癌ⅠB3期病例,在真实世界研究比较ARH组、NACT组及R-CT组的5年总体生存率(OS)及无病生存率(DFS)。结果(1)从数据库中纳入FIGO 2018子宫颈癌ⅠB3期病例1434例,其中ARH组830例、NACT组484例、R-CT组120例。中位随访时间为46个月(ARH组55个月、NACT组44个月、R-CT组32个月)。(2)NACT组、ARH组及R-CT组之间5年OS差异有统计学意义(97.0%vs.91.1%vs.78.1%,P<0.001),5年DFS差异有统计学意义(92.3%vs.87.4%vs.71.1%,P<0.001)。(3)Cox回归分析提示NACT组发生死亡的风险是ARH组的0.352倍(HR=0.352,95%CI 0.189~0.654,P=0.001),不是复发/死亡的独立影响因素(HR=0.592,95%CI 0.391~0.898,P=0.202);R-CT组发生死亡的风险是ARH组的2.997倍(HR=2.997,95%CI 1.754~5.121,P<0.001),R-CT组发生复发/死亡的风险是ARH组的2.832倍(HR=2.832,95%CI 1.803~4.449,P<0.001)。结论比较3种治疗方式的肿瘤学结局,FIGO 2018子宫颈癌ⅠB3期接受新辅助化疗后开腹手术的肿瘤学结局最佳,接受开腹广泛性子宫切除手术次之,接受根治性放化疗较差。因此,ⅠB3期的合适治疗方式可能是新辅助化疗后手术。Objective Based on the perspective of oncological outcomes,the comparison was made among abdominal radical hysterectomy(ARH),neoadjuvant chemotherapy followed by surgery(NACT),and radical radio-chemotherapy(R-CT)to explore the appropriate treatment strategy for FIGO 2018 new stageⅠB3 cervical cancer.Methods Based on the clinical diagnosis and treatment for cervical cancer in China,the patients with FIGO 2018 stageⅠB3 cervical cancer were included,and the 5-year overall survival(OS)and disease-free survival(DFS)of ARH group,NACT group and R-CT group were compared in realworld study.Results(1)A total of 1434 patients with FIGO 2018 stageⅠB3 cervical cancer were included,including 830 patients in the ARH group,484 patients in the NACT group,and 120 patients in the R-CT group.The median follow-up period was 46 months(55 months for ARH,44 months for NACT,and 32 months for R-CT).(2)The 5-year OS difference among the NACT group,ARH group and R-CT group was statistically significant(97.0%vs.91.1%vs.78.1%,P<0.001),and the 5-year DFS difference was statistically significant(92.3%vs.87.4%vs.71.1%,P<0.001).(3)Multivariate analysis suggested that the NACT group had a 0.352 times higher risk of death than the ARH group(HR=0.352,95%CI 0.189-0.654,P=0.001),and was not an independent influencing factor for recurrence/death(HR=0.592,95%CI 0.391-0.898,P=0.202);the risk of death in the R-CT group was 2.997 times that in the ARH group(HR=2.997,95%CI 1.754-5.121,P<0.001),and the risk of recurrence/death was 2.832 times that in the ARH group(HR=2.832,95%CI 1.803-4.449,P<0.001).Conclusions Comparing the oncological outcomes of the three treatments,the oncological outcomes of NACT group are the best,the ARH group the second,and the R-CT group the worst.Therefore,the appropriate treatment for FIGO 2018 stageⅠB3 cervical cancer may be neoadjuvant chemotherapy followed by surgery.

关 键 词：子宫颈肿瘤 FIGO 2018 ⅠB3期 治疗策略 肿瘤学结局 

分 类 号：R737.3[医药卫生—肿瘤]