[Value of postoperative radiotherapy and analysis of prognostic factors in early-stage neuroendocrine carcinoma of cervix].

X C Song, H Zhang, S Zhong, X J Tan, S Q Ma, Y Jin, L Y Pan, M Wu, D Y Cao, J X Yang, Y Xiang
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引用次数: 0

Abstract

Objective: To evaluate the effect of postoperative radiotherapy and high-risk pathological factors on the prognosis of early-stage neuroendocrine carcinoma of cervix (NECC). Methods: A single-center retrospective cohort study of early-stage NECC in Peking Union Medical College Hospital from January 2011 to April 2022 were enrolled. The patients were treated with radical hysterectomy±adjuvant treatment. They were divided into postoperative non-radiation group and postoperative radiation group. The possible postoperative recurrence risk factors identified by univariate analysis were assessed using multivariate logistic regression. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results: (1) Sixty-two cases were included in the study, including 33 cases in postoperative non-radiation group and 29 cases in postoperative radiation group. (2) The median follow-up time was 37 months (ranged 12-116 months), with 23 cases (37%) experienced recurrences. There were 7 cases (11%) pelvic recurrences and 20 cases (32%) distant recurrences, in which including 4 cases (6%) both pelvic and distant recurrences. Compared with postoperative non-radiation group, the postoperative radiation group had a lower pelvic recurrence rate (18% vs 3%; P=0.074) but without statistic difference, a slightly elevated distant recurrence rate (24% vs 41%; P=0.150) and overall recurrence rate (33% vs 41%; P=0.513) without statistically significances. Univariate analysis showed that lymph-vascular space invasion and the depth of cervical stromal invasion≥1/2 were risk factors for postoperative recurrence (all P<0.05). Multivariate analysis showed lymph-vascular space invasion was an independent predictor for postoperative recurrence (OR=23.03, 95%CI: 3.55-149.39, P=0.001). (3) During the follow-up period, 18 cases (29%, 18/62) died with tumor, with 10 cases (30%, 10/33) in postoperative non-radiation group and 8 cases (28%, 8/29) in postoperative radiation group, without significant difference (P=0.814). The postoperative 3-year and 5-year survival rate was 79.2%, 60.8%. The depth of cervical stromal invasion≥1/2 was more common in postoperative radiation group (27% vs 64%; P=0.011), and postoperative radiation in such patients showed an extended trend in PFS (32.3 vs 53.9 months) and OS (39.4 vs 73.4 months) but without statistic differences (P=0.704, P=0.371). Compared with postoperative non-radiation group, the postoperative radiation did not improve PFS (54.5 vs 37.3 months; P=0.860) and OS (56.2 vs 62.4 months; P=0.550) in patients with lymph-vascular space invasion. Conclusions: Postoperative radiation in early-stage NECC patients has a trend to reduce pelvic recurrence but not appear to decrease distant recurrence and overall recurrence, and has not improved mortality. For patients with the depth of cervical stromal invasion≥1/2, postoperative radiation has a trend of prolonging OS and PFS but without statistic difference. Lymph-vascular space invasion is an independent predictor for postoperative recurrence, but postoperative radiation in such patients does not seem to have any survival benefits.

[术后放疗在早期宫颈神经内分泌癌中的价值及预后因素分析]。
目的:评价早期宫颈神经内分泌癌(NECC)术后放疗及高危病理因素对预后的影响。方法:采用2011年1月至2022年4月在北京协和医院进行的早期NECC单中心回顾性队列研究。采用子宫切除术+辅助治疗。他们被分为术后非放疗组和术后放疗组。通过单变量分析确定的可能的术后复发风险因素采用多变量逻辑回归进行评估。Kaplan-Meier方法用于分析无进展生存期(PFS)、总生存期(OS)、复发率和死亡率。结果:(1)本研究共纳入62例,其中术后非放疗组33例,术后放疗组29例。(2) 中位随访时间为37个月(12-116个月),23例(37%)复发。盆腔复发7例(11%),远处复发20例(32%),其中盆腔和远处复发4例(6%)。与术后无放疗组相比,术后放疗组盆腔复发率较低(18%vs 3%;P=0.074),但无统计学差异,远处复发率略高(24%vs 41%;P=0.0150),总复发率(33%vs 41%;P=0.513),无统计学意义。单因素分析显示,淋巴血管间隙侵犯和宫颈间质侵犯深度≥1/2是术后复发的危险因素(POR=23.03,95%CI:3.55-149.39,P=0.001)。(3)随访期间,18例(29%,18/62)死于肿瘤,术后非放疗组10例(30%,10/33),放疗组8例(28%,8/29),术后3年、5年生存率分别为79.2%、60.8%,放疗组宫颈间质浸润深度≥1/2者较多(27%对64%;P=0.011),术后放疗组PFS(32.3个月vs 53.9个月)和OS(39.4个月vs 73.4个月)均有延长趋势,但无统计学差异(P=0.704,P=0.371)。结论:早期NECC患者术后放疗有减少盆腔复发的趋势,但似乎没有减少远处复发和整体复发,也没有提高死亡率。对于宫颈间质浸润深度≥1/2的患者,术后放疗有延长OS和PFS的趋势,但无统计学差异。淋巴血管间隙侵犯是术后复发的独立预测因素,但这类患者的术后放疗似乎没有任何生存益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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