2018年FIGO子宫颈癌新分期中ⅡA2期治疗策略的探讨

Treatment strategy for stageⅡA2 cervical cancer in FIGO new stage 2018

目的探讨2018年FIGO子宫颈癌新分期中ⅡA2期治疗策略。方法基于中国子宫颈癌临床诊疗项目大数据库,对47家医院于2004—2018年期间收治的1112例FIGO 2018ⅡA2期子宫颈癌病例,在真实世界研究条件下比较开腹广泛性子宫切除手术(ARH组)、新辅助化疗后行手术治疗(NACT组)、根治性放化疗(R-CT组)3种治疗方式的5年总体生存率(OS)及无瘤生存率(DFS)。结果(1)从数据库中共筛选出ARH组471例,NACT组342例,R-CT组299例,中位随访时间45个月。(2)单因素分析结果,ARH组与NACT组5年OS和5年DFS差异无统计学意义(93.6%vs.90.3%,P=0.068;90.0%vs.84.5%,P=0.123);ARH组、NACT组肿瘤学结局均优于R-CT组(ARH vs.R-CT 5年OS:93.6%vs.71.8%,P<0.001;5年DFS:90.0%vs.69.4%,P<0.001;NACT vs.R-CT 5年OS:90.3%vs.71.8%,P<0.001;5年DFS:84.5%vs.69.4%,P<0.001)。(3)多因素分析结果,R-CT组是影响子宫颈癌患者死亡及复发/死亡的独立危险因素。结论对于FIGO 2018ⅡA2期子宫颈癌患者,直接开腹手术或新辅助化疗后手术可能是更好的选择。

Objective To explore the treatment strategy for FTGO 2018 new stageⅡA2 of cervical cancer.Methods Based on the big data databases of clinical diagnosis and treatment project for cervical cancer in China,1112 cases of FIGO 2018ⅡA2 cervical cancer admitted to 47 hospitals from 2004 to 2018 were analyzed.The 5-year OS and 5-year DFS of the three treatment regimens-direct open extensive hysterectomy(ARH group),neoadjuvant chemotherapy(NACT group)and radical radiochemotherapy(R-CT group)were compared in real world conditions.Results(1)A total of 471 cases in the ARH group,342 cases in the NACT group and 299 cases in the R-CT group were selected from the 1538 project database,and the median follow-up was 45 months.(2)Univariate analysis showed that 5-year OS and 5-year DFS were not significantly different between the ARH group and the NACT group(93.6%vs.90.3%,P=0.068;90.0%vs.84.5%,P=0.123).The tumor outcomes in the ARH and NACT groups were better than those in the RCT group(for ARH vs.R-CT,5-year OS:93.6%vs.71.8%,P<0.001;5-year DFS:90.0%vs.69.4%,P<0.001),(for NACT vs.R-CT,5-year OS:90.3%vs.71.8%,P<0.001;5-year DFS:84.5%vs.69.4%,P<0.001).(3)Multivariate analysis showed that the R-CT group was an independent risk factor for death and recurrence/death of patients with cervical cancer.Conclusion For FIGO 2018 stageⅡA2 cervical cancer,direct open surgery or surgery after neoadjuvant chemotherapy may be better options.