FIGO分期系统改变后Ⅰb3、Ⅱa2期宫颈癌不同治疗方式的预后分析

The prognosis analysis of different treatment methods forⅠb3 andⅡa2 stage cervical cancer after the modification of FIGO staging system

目的:探究基于旧分期系统的Ⅰb2期、Ⅱa2期宫颈癌治疗建议是否仍适用新分期系统Ⅰb3期、Ⅱa2期宫颈癌。方法:收集2013年1月至2017年12月在云南省肿瘤医院确诊为Ⅰb2、Ⅱa2期(2009版FIGO分期)宫颈癌患者,根据2018版分期系统筛选出Ⅰb3、Ⅱa2期患者。分别比较新旧分期系统手术组与放疗组5年总生存期(OS)、无病生存期(DFS),以及比较新旧分期系统中手术组与放疗组、新辅助化疗与未行新辅助化疗的OS、DFS。结果:依据旧分期系统手术组纳入患者253例,其中Ⅰb2期199例(78.7%),Ⅱa2期54例(21.3%);放疗组71例,其中Ⅰb2期38例,Ⅱa2期33例。依据新分期系统手术组纳入患者200例,其中Ⅰb3期160例,Ⅱa2期例40例;放疗组41例,其中Ⅰb3期19例,Ⅱa2期22例。基于旧分期系统整体手术组和放疗组的DFS分别为79.8%和77.5%(P=0.42),OS分别为82.6%和70.4%(P=0.0075)。基于新分期系统整体手术组和放疗组的DFS分别为84%和75.5%(P=0.17),OS分别为86.5%和70.7%(P=0.0068)。基于旧分期系统Ⅰb2期手术组和放疗组的DFS分别为83.4%和84.2%(P=0.84),OS分别为86.9%和81.6%(P=0.35);Ⅱa2期手术组和放疗组的DFS分别为66.7%和69.7%(P=0.8),OS分别为66.7%和55.7%(P=0.13)。基于新分期系统Ⅰb3期手术组和放疗组的DFS分别为88.1%和68.4%(P=0.028),OS分别为90.0%和73.3%(P=0.036);Ⅱa2期手术组和放疗组的DFS分别为67.5%和81.1%(P=0.39),OS分别为70.0%和68.2%(P=0.62)。基于旧分期系统:整体手术组中新辅助化疗和未新辅助化疗DFS(P=0.93)、OS(P=0.92)无显著差异;放疗组中新辅助化疗DFS(P=0.64)、OS(P=0.44)无显著差异。基于新分期系统:整体手术组中新辅助化疗和未新辅助化疗DFS(P=0.8)、OS(P=0.8)无显著差异;整体放疗组中新辅助化疗组显示较差DFS(P=0.0089)及OS(P=0.012)。结论:无论新分期系统或旧分期系统手术组OS均高于放疗组,而DFS无显著差异;基于新分期系统手术改善Ⅰb3期患者DFS、OS;无论新分期系统或旧分期系统新辅助化疗未能改善患者手术或放疗患者预后。

Objective:To explore whether treatment recommendations for stageⅠb2 andⅡa2 cervical cancer based on the old staging system are still applicable to stageⅠb3 andⅡa2 cervical cancer in the new staging system.Methods:Patients diagnosed with stageⅠb2 andⅡa2 cervical cancer(2009 FIGO staging)at Yunnan Cancer Hospital from January 2013 to December 2017 were collected.Patients with stageⅠb3 andⅡa2 were screened according to the 2018 staging system.The 5-year overall survival(OS)and disease-free survival(DFS)of the surgery group and radiotherapy group were compared between the new and old staging systems.Additionally,the OS and DFS of patients who received neoadjuvant chemotherapy versus those who did not in both the surgery and radiotherapy groups were compared under both staging systems.Results:According to the old staging system,253 patients were included in the surgery group,with 199 cases(78.7%)in stageⅠb2 and 54 cases(21.3%)in stageⅡa2.In the radiotherapy group,there were 71 cases,with 38 in stageⅠb2 and 33 in stageⅡa2.According to the new staging system,200 patients were included in the surgery group,with 160 cases in stageⅠb3 and 40 cases in stageⅡa2.In the radiotherapy group,there were 41 cases,with 19 in stageⅠb3 and 22 in stageⅡa2.Based on the old staging system,the overall DFS for the surgery group and the radiotherapy group was 79.8%and 77.5%(P=0.42),OS was 82.6%and 70.4%(P=0.0075).Based on the new staging system,the overall DFS for the surgery group and the radiotherapy group was 84%and 75.5%(P=0.17),OS was 86.5%and 70.7%(P=0.0068).Based on the old staging system,the DFS for the surgery group vs the radiotherapy group in stageⅠb2 was 83.4%and 84.2%(P=0.84),OS was 86.9%and 81.6%(P=0.35).For stageⅡa2,the DFS for the surgery group vs the radiotherapy group was 66.7%and 69.7%(P=0.8),OS was 66.7%and 55.7%(P=0.13).Based on the new staging system,the DFS for the surgery group vs the radiotherapy group in stageⅠb3 was 88.1%and 68.4%(P=0.028),OS was 90%and 73.3%(P=0.036).For stageⅡa2,the DFS for the surgery group and the radiotherapy group was 67.5%and 81.1%(P=0.39),and OS was 70%and 68.2%(P=0.62).Based on the old staging system,there was no significant difference in DFS(P=0.93)and OS(P=0.92)between patients who received neoadjuvant chemotherapy and those who did not in the overall surgery group;similarly,no significant difference was found in the radiotherapy group for DFS(P=0.64)and OS(P=0.44).Based on the new staging system,there was no significant difference in DFS(P=0.8)and OS(P=0.8)between patients who received neoadjuvant chemotherapy and those who did not in the overall surgery group.However,the overall radiotherapy group showed worse DFS(P=0.0089)and OS(P=0.012)in the neoadjuvant chemotherapy group.Conclusion:Regardless of the new staging system or the old staging system,the surgery group had higher OS compared to the radiotherapy group,while there was no significant difference in DFS.Based on the new staging system,surgery improved DFS and OS for stageⅠb3 patients.Neoadjuvant chemotherapy did not improve prognosis for patients undergoing surgery or radiotherapy under either the new or old staging system.