基于大数据的2018年FIGO子宫颈癌新分期ⅡA1期治疗策略探讨  

Investigation of treatment strategy for FIGO 2018 stageⅡA1 cervical cancer based on big data

作　　者：陈晓林[1] 段慧[1] 赵宏伟[2] 孙立新[2] 王莉[3] 康山 倪妍 陈必良 崔竹梅[7] 宾晓农 郎景和 刘萍[1] 陈春林[1] CHEN Xiao-lin;DUAN Hui;ZHAO Hong-wei;SUN Li-xin;WANG Li;KANG Shan;NI Yan;CHEN Bi-liang;CUI Zhu-mei;BIN Xiao-nong;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]山西省肿瘤医院妇科,山西太原030013 [3]河南省肿瘤医院妇科,河南郑州450008 [4]河北医科大学第四医院妇科,河北石家庄050000 [5]运城市中心医院妇产科,山西运城044000 [6]空军军医大学西京医院妇科,陕西西安710032 [7]青岛大学附属医院妇产科,山东青岛266000 [8]广州医科大学公共卫生学院,广东广州511436 [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10期1034-1038,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：十二五国家科技支撑计划(2014BAI05B03);国家自然科学基金(81272585);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：目的对比子宫颈癌FIGO 2018新分期ⅡA1期患者不同治疗方法的肿瘤学结局,探讨2018年FIGO新分期下ⅡA1期子宫颈癌的治疗策略。方法基于中国子宫颈癌临床诊疗项目大数据库(1538项目数据库),分别纳入接受直接开腹手术(ARH组)、术前新辅助化疗后手术(NACT组)和根治性放化疗(R-CT组)治疗的FIGO 2018ⅡA1期子宫颈癌患者,比较3种治疗方法的5年总体生存率(OS)和无病生存率(DFS)。结果(1)基于1538项目数据库,共纳入FIGO 2018ⅡA1期子宫颈癌1724例,包括ARH组(n=1308)、NACT组(n=193)和R-CT组(n=223),中位随访时间为45个月(ARH组48个月,NACT组43个月,R-CT组31个月)。(2)在整体队列中对3组进行生存分析显示,3组之间总体的5年OS和DFS差异有统计学意义(P<0.001)。其中ARH组5年OS和DFS虽均优于NACT组,但差异无统计学意义(OS:92.5%vs.89.6%,P=0.073;DFS:87.9%vs.87.7%,P=0.562);R-CT组的5年OS和DFS均较ARH组(OS:80.9%vs.92.5%,P<0.001;DFS:74.4%vs.87.9%,P<0.001)和NACT组(OS:80.9%vs.89.6%,P=0.04;DFS:74.4%vs.87.7%,P=0.003)差。(3)Cox回归分析显示,相较于ARH,R-CT是ⅡA1期子宫颈癌患者死亡和复发/死亡的独立危险因素(OS:HR=1.675,95%CI 1.342~2.091,P<0.001;DFS:HR=1.537,95%CI1.286~1.837,P<0.001),ARH和NACT之间的死亡和复发/死亡风险均差异无统计学意义(OS:HR=1.713,95%CI0.994~2.953,P=0.053;DFS:HR=1.118,95%CI 0.697~1.793,P=0.645)。结论初始治疗为ARH和NACT可使FIGO 2018ⅡA1期子宫颈癌患者预后获益最大,R-CT不利于其肿瘤学预后,从卫生经济学角度ARH是ⅡA1期子宫颈癌患者的首选治疗方法。Objective To compare the oncological outcomes of different treatment methods for patients with FIGO 2018 new stageⅡA1 cervical cancer,and to explore the treatment strategy for FIGO 2018 new stageⅡA1 cervical cancer.Methods based on the Chinese cervical cancer clinical diagnosis and treatment project database(1538 project database),the patients with FIGO2018ⅡA1 cervical cancer treated with direct laparotomy(ARH group),surgery after preoperative neoadjuvant chemotherapy,(NACT group)and radical chemoradiotherapy(R-CT group)were included respectively.The 5-year OS and DFS of the three treatment methods were compared.Results(1)Based on the 1538 project database,1724 cases of FIGO 2018ⅡA1 cervical cancer were included,including ARH group(n=1308),NACT group(n=193)and R-CT group(n=223).The median follow-up time was 45 months(48 months in ARH group,43 months in NACT group and 31 months in R-CT group).(2)Survival analysis of the three groups in the overall cohort showed that there were significant differences in overall 5-year OS and DFS among the three groups(P<0.001).Although the 5-year OS and DFS in ARH group were better than those in NACT group,the difference was not statistically significant(OS:92.5%vs.89.6%,P=0.073;DFS:87.9%vs.87.7%,P=0.562).The 5-year OS and DFS in R-CT group were higher than those in ARH group(OS:80.9%vs.92.5%,P<0.001;DFS:74.4%vs.87.9%,P<0.001)and NACT group(OS:80.9%vs.89.6%,P=0.04;DFS:74.4%vs.87.7%,P=0.003).(3)Cox multivariate analysis showed that compared with ARH R-CT was an independent risk factor for death and recurrence/death in patients with stageⅡA1 cervical cancer(OS:HR=1.675,95%CI 1.342-2.091,P<0.001;DFS:HR=1.537,95%CI 1.286-1.837,P<0.001).There was no difference in the risk of death or recurrence/death between ARH and NACT(OS:HR=1.713,95%CI 0.994-2.953,P=0.053;DFS:HR=1.118,95%CI 0.697-1.793,P=0.645).Conclusion The initial treatment with ARH and NACT can result in the best prognosis of patients with FIGO 2018 stageⅡA1 cervical cancer,and R-CT is not conducive to their oncologi

关 键 词：子宫颈肿瘤 国际妇产科联盟 ⅡA1期 肿瘤学预后 治疗策略 

分 类 号：R737.3[医药卫生—肿瘤]