Surgery plus post-operative radiotherapy versus definitive chemoradiotherapy in locally advanced endocervical adenocarcinoma.

IF 4.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Jong Yun Baek, Won Park, Won Kyung Cho, Hyun-Soo Kim, Byoung-Gie Kim, Jeong-Won Lee, Chel Hun Choi, Tae-Joong Kim, Yoo-Young Lee
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引用次数: 0

Abstract

Objective: This study evaluated whether treatment outcomes for endocervical adenocarcinoma differ according to treatment modality (surgery plus post-operative radiotherapy versus definitive chemoradiotherapy) and human papillomavirus (HPV) status.

Methods: We retrospectively analyzed 105 patients with clinical stage IIB to IIIC endocervical adenocarcinoma, classified according to the 2018 International Federation of Gynecology and Obstetrics staging system, who were treated with surgery plus post-operative radiotherapy or definitive chemoradiotherapy at a single institution between 2011 and 2022. HPV status was determined based on the 2020 World Health Organization classification. Among the 105 patients, 61 had HPV-associated tumors and 44 had HPV-independent tumors. Patients were categorized into 4 groups: HPV-associated surgery plus post-operative radiotherapy (n = 46), HPV-associated definitive chemoradiotherapy (n = 15), HPV-independent surgery plus post-operative radiotherapy (n = 27), and HPV-independent definitive chemoradiotherapy (n = 17). Progression-free survival, locoregional recurrence-free survival, and overall survival were evaluated.

Results: Baseline characteristics differed significantly among the 4 groups, particularly in clinical stage, tumor size, and parametrial invasion. The 3-year progression-free, locoregional recurrence-free, and overall survival rates were 47.4%, 54.7%, and 69.8%, respectively. By group, survival rates were 55.4%, 66.4%, and 76.9% for HPV-associated surgery plus post-operative radiotherapy; 52.5%, 52.5%, and 93.3% for HPV-associated definitive chemoradiotherapy; and 54.3%, 56.8%, and 67.5% for HPV-independent surgery plus post-operative radiotherapy, compared with significantly poorer rates of 11.8%, 20.6%, and 33.1% for HPV-independent definitive chemoradiotherapy (p < .05). These differences remained significant after multivariate adjustment, while no significant survival differences were observed between other groups. In a sub-group analysis of HPV-independent patients with clinical T2 to T3 disease, definitive chemoradiotherapy remained associated with worse outcomes than surgery plus post-operative radiotherapy.

Conclusions: Definitive chemoradiotherapy showed outcomes comparable to surgery plus post-operative radiotherapy in HPV-associated adenocarcinoma, but was associated with significantly worse survival in HPV-independent cases. Further studies are warranted to confirm these findings.

局部晚期宫颈内膜腺癌的手术加术后放疗与确定性放化疗的比较。
目的:本研究评估宫颈内腺癌的治疗结果是否因治疗方式(手术加术后放疗与确定性放化疗)和人乳头瘤病毒(HPV)状态而不同。方法:回顾性分析105例临床分期IIB至IIIC期宫颈内膜腺癌患者,根据2018年国际妇产科学联合会分期系统进行分类,这些患者于2011年至2022年在单一机构接受手术加术后放疗或终期放化疗。HPV状态是根据2020年世界卫生组织分类确定的。105例患者中,61例为hpv相关肿瘤,44例为hpv非依赖型肿瘤。患者分为4组:hpv相关手术加术后放疗(n = 46), hpv相关终期放化疗(n = 15), hpv独立手术加术后放疗(n = 27), hpv独立终期放化疗(n = 17)。评估无进展生存期、局部无复发生存期和总生存期。结果:4组患者的基线特征有显著差异,特别是在临床分期、肿瘤大小和参数浸润方面。3年无进展、无局部复发和总生存率分别为47.4%、54.7%和69.8%。hpv相关手术加术后放疗组生存率分别为55.4%、66.4%和76.9%;hpv相关的最终放化疗为52.5%、52.5%和93.3%;不依赖hpv的手术加术后放疗的发生率分别为54.3%、56.8%和67.5%,而不依赖hpv的最终放化疗的发生率分别为11.8%、20.6%和33.1%,差异有统计学意义(p < 0.05)。在多因素调整后,这些差异仍然显著,而其他组之间的生存率无显著差异。在临床T2至T3疾病的hpv独立患者的亚组分析中,明确的放化疗仍然比手术加术后放疗的预后更差。结论:在hpv相关的腺癌中,明确的放化疗显示出与手术加术后放疗相当的结果,但在hpv无关的病例中,放化疗与明显较差的生存率相关。需要进一步的研究来证实这些发现。
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来源期刊
CiteScore
6.60
自引率
10.40%
发文量
280
审稿时长
3-6 weeks
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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