The impact of chemotherapy on survival in patients aged ≥65 years with locoregionally cervical cancer who undergo radiotherapy: a Surveillance, Epidemiology, and End Results database analysis.
JunFang Liao, Tie Xu, JiaoMei Zhou, NanJie Xiao, Man Zhao, TianShu Zhao, Miao Peng, ZhiJian Chen
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引用次数: 0
Abstract
Objective: Cervical cancer remains a global health challenge, particularly among patients aged ≥65 years, who often face poorer outcomes. This study aims to evaluate the clinical significance of chemotherapy in older patients (≥65 years) who undergo definitive radiotherapy for cervical cancer, using data from the Surveillance, Epidemiology, and End Results database.
Methods: A retrospective cohort study was conducted using data from the Surveillance, Epidemiology, and End Results 18 Registries, focusing on patients with cervical cancer aged ≥65 years who were diagnosed between 2004 and 2017. Patients receiving surgery or those without radiotherapy were excluded. Propensity score matching was used to balance the baseline characteristics in patients treated with and those without chemotherapy. Overall survival and cancer-specific survival were analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models.
Results: A total of 2958 patients met the inclusion criteria, and 69.8% (n = 2067) received chemotherapy. Chemotherapy significantly improved 5- and 10-year overall survival rates (47.8% vs 26.9%, 28.5% vs 11.1%, respectively; HR 0.55, 95% CI 0.49 to 0.61, p < .0001) and cancer-specific survival rates (58.7% vs 43.8%, 48.3% vs 38.7%, HR 0.64, 95% CI 0.56 to 0.73). Multi-variate analysis identified chemotherapy, International Federation of Gynecology and Obstetrics stage, and histology as independent prognostic factors for both overall survival and cancer-specific survival. The impact of chemotherapy decreased slightly in more advanced stages, particularly stage IVA, but remained beneficial in earlier stages and among the oldest age groups (≥85 years).
Conclusions: Chemotherapy significantly improves both overall survival and cancer-specific survival in patients aged ≥65 years with locoregionally advanced cervical cancer who undergo radiotherapy. These findings strongly support the inclusion of chemotherapy in treatment regimens for older patients, regardless of age, to optimize survival outcomes and ensure comprehensive care. Further research is essential to develop better strategies for managing advanced-stage diseases in older patients.
目的：宫颈癌仍然是一个全球性的健康挑战，特别是在年龄≥65岁的患者中，他们往往面临较差的结果。本研究旨在利用来自监测、流行病学和最终结果数据库的数据，评估接受宫颈癌最终放疗的老年患者（≥65岁）化疗的临床意义。方法：回顾性队列研究使用来自监测、流行病学和最终结果18个登记处的数据，重点研究2004年至2017年间诊断的年龄≥65岁的宫颈癌患者。排除接受手术或未接受放疗的患者。倾向评分匹配用于平衡接受化疗和未接受化疗患者的基线特征。采用Kaplan-Meier曲线、log-rank检验和Cox比例风险模型分析总生存率和癌症特异性生存率。结果：2958例患者符合纳入标准，其中69.8% （n = 2067）患者接受了化疗。化疗显著提高5年和10年总生存率(分别为47.8%对26.9%，28.5%对11.1%；HR 0.55, 95% CI 0.49 ~ 0.61, p < 0.0001)和癌症特异性生存率（58.7% vs 43.8%, 48.3% vs 38.7%, HR 0.64, 95% CI 0.56 ~ 0.73）。多因素分析发现，化疗、国际妇产科联合会分期和组织学是总生存期和癌症特异性生存期的独立预后因素。化疗的影响在较晚期阶段，特别是IVA阶段略有下降，但在早期阶段和年龄最大的年龄组（≥85岁）中仍然有益。结论：化疗可显著提高≥65岁局部区域晚期宫颈癌放疗患者的总生存率和肿瘤特异性生存率。这些发现强烈支持将化疗纳入老年患者的治疗方案，无论年龄大小，以优化生存结果并确保全面护理。进一步的研究对于制定更好的策略来管理老年患者的晚期疾病至关重要。
期刊介绍：
The International Journal of Gynecological Cancer, the official journal of the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology, is the primary educational and informational publication for topics relevant to detection, prevention, diagnosis, and treatment of gynecologic malignancies. IJGC emphasizes a multidisciplinary approach, and includes original research, reviews, and video articles. The audience consists of gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, and research scientists with a special interest in gynecological oncology.
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