中国实用妇科与产科杂志2024，Vol.40Issue(9)：924-931,8.DOI:10.19538/j.fk2024090116
子宫颈腺鳞癌根治性放化疗与开腹手术肿瘤学结局对比研究
A comparative study on oncological outcomes between radical chemoradiotherapy and primary laparotomic open surgery for cervical adenosquamous carcinoma
摘要
Abstract
Objective To investigate the oncological outcomes of radical chemoradiotherapy versus abdominal hysterectomy in patients with adenosquamous carcinoma of the cervix.Methods Patients with adenosquamous carcinoma of the cervix were selected from the Chinese cervical cancer clinical treatment programs.The 2018 FIGO staging classification was uesd as the stratification basis to compare the oncological outcomes of patients undergoing radical chemoradiotherapy and those undergoing abdominal hysterectomy.Results(1)Initial cohort:The radical chemoradiotherapy group consisted of 97 cases,while the abdominal hysterectomy group included 373 cases.The 5-year overall survival(OS)and disease-free survival(DFS)rates in the radical chemoradiotherapy group were both inferior to those in the abdominal hysterectomy group(OS:69.2％vs.83.7％,P＜0.001;DFS:57.8％vs.81.3％,P＜0.001).Cox multivariate analysis indicated that radical chemoradiotherapy was an independent risk factor affecting patient prognosis(OS:HR=2.094,95％CI 1.243～3.530,P=0.006;DFS:HR=2.477,95％CI 1.585～3.871,P＜0.001).(2)For FIGO stage Ⅱ B and earlier:36 patients in the chemoradiotherapy group and 248 in the abdominal hysterectomy group.There was no statistical difference in 5-year OS and DFS between the two groups(OS:89.9％vs.88.3％,P=0.813;DFS:83.6％vs.86.7％,P=0.510).Cox multivariate analysis suggested no statistical difference in prognosis between the two groups(OS:HR=0.731,95％CI 0.152～3.520,P=0.696;DFS:HR=0.726,95％CI 0.218～2.417,P=0.601).(3)For FIGO stage ⅢC:20 patients in the chemoradiotherapy group and 100 in the abdominal hysterectomy group.Both 5-year OS and DFS indicated that the abdominal hysterectomy group had better oncological outcomes(OS:44.6％vs.65.9％,P=0.007;DFS:39.7％vs.61.5％,P=0.012).Cox multivariate analysis suggested no statistical difference in prognosis between the two groups(OS:HR=2.091,95％CI 0.936～4.672,P=0.072;DFS:HR=1.748,95％CI 0.827～3.692,P=0.143).(4)For FIGO stage Ⅲ-Ⅳ:48 patients in the chemoradiotherapy group and 102 in the abdominal hysterectomy group.There was no significant difference in 5-year OS,but the abdominal hysterectomy group had a better 5-year DFS(OS:58.7％vs.66.9％,P=0.160;DFS:38.9％vs.62.4％,P=0.012).Cox multivariate analysis indicated no difference in prognosis between the two groups(OS:HR=2.126,95％CI 0.998～4.537,P=0.051;DFS:HR=1.855,95％CI 0.914～3.766,P=0.087).Conclusions Overall,the oncological outcomes for patients with adenosquamous carcinoma of the cervix were worse in the radical chemoradiotherapy group compared to the abdominal hysterectomy group.However,further stratified analysis using Cox multivariate analysis showed no significant difference in the 5-year oncological outcomes between the two treatment modalities,regardless of whether patients were within stage Ⅱ B or above stage Ⅱ B.关键词
子宫颈肿瘤/根治性放化疗/开腹手术/肿瘤学结局Key words
cervical neoplasms/radical chemoradiotherapy/laparotomy/oncological outcomes分类
医药卫生引用本文复制引用
王昱俨,郎景和,刘萍,彭程,尹钊红,陈春林,丁红梅,孙立新,王莉,李维丽..子宫颈腺鳞癌根治性放化疗与开腹手术肿瘤学结局对比研究[J].中国实用妇科与产科杂志,2024,40(9):924-931,8.基金项目
十二五国家科技支撑计划(2014BAI05B03) （2014BAI05B03）
广州市科技计划(158100075) （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) （LC2016ZD019）
