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Objective To explore the prognostic factors for the recurrence of vaginal stump of earlystage cervical cancer after radical hysterectomy and evaluate the effect on clinical prognosis.Methods Clinical data of stage Ⅰ-ⅡA cervical cancer patients undergoing radical hysterectomy in Guizhou Cancer Hospital from January,2007 to December,2016 were retrospectively analyzed.Results A total of 493 patients were enrolled and followed up until May 30,2018.Among them,96.6％(474/493) completed the follow-up.The median age was 45 years.Patients aged 40-50 years had a high incidence rate.In total,451 cases (91.48％) had no recurrence of vaginal stump.The average time without stump recurrence was 51.2 months and the median time without stump recurrence was 44.8 months.Multivariate Cox regression analysis demonstrated that pelvic external irradiation and brachytherapy were the independent prognostic factors for the recurrence of vaginal stump (P=0.000,0.000).Tumor size,lymph node metastasis and pelvic external irradiation were the independent prognostic factors for overall survival (P=0.045,0.022,0.000).Conclusions Pelvic external irradiation and brachytherapy play an extremely pivotal role in reducing the risk of vaginal stump recurrence after radical hysterectomy for patients with stage Ⅰ-Ⅱ A cervical cancer.Tumor size,lymph node metastasis and pelvic external irradiation are the independent prognostic factors for overall survival of patients with stage Ⅰ-Ⅱ A cervical cancer following radical hysterectomy.
Assuntos
Traquelectomia/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Feminino , Humanos , Vagina , Adulto JovemRESUMO
Objective To analyze the clinical outcome and prognostic factors of concurrent radiochemotherapy (CRCT) or radiotherapy (RT) alone followed by radical hysterectomy in cervical cancer.MethodsBetween April 2006 and June 2011,182 patients with FIGO ⅠB2-ⅢB cervical carcinoma were treated with preoperative CRCT ( 123 patients) or RT alone ( 59 patients) followed by radical surgery.Weekly cisplatin (40 mg/m2)were administered during radiotherapy for patients treated with CRCT.Preoperative RT doses were 40-50 Gy in 20-25 fractions.Total hysterosalpingo-oophorectomy and pelvic lymph node dissection was performed 2-3 weeks after neoadjuvant therapy.The prognostic factors were analyzed by Cox-regression method.ResultsSixty-nine patients were followed up for 3 years.For patients with tumor ≥4.5 cm,there were no significant differences in the 3-year progression-free survival (PFS) and overall survival (OS) rates between CRCT and RT alone ( x2 =1.84 and 1.56,P =0.176 and 0.221 ).For patients with tumor ＜ 4.5 cm,CRCT group had higher PFS and OS rates than RT alone ( x2 =5.22 and 4.81,P=0.022 and 0.018).The 3-year PFS and OS rates were 92.0％ and 93.8％.By multivariate analysis,tumor diameter ( ≥6 cm vs.＜ 6 cm) was significant prognostic factor for PFS and OS (x2 =2.56,P =0.011 ;x2 =4.06,P =0.007 ),age ( ＜ 48 vs.≥ 48 years) was significant prognostic factor for OS (x2=4.86,P =0.046),and postoperative lymph node status (positive vs.negative) was significant prognostic factor for PFS ( x2 =1.04,P =0.010).ConclusionsTreatment with CRCT or RT followed by radical surgery has achieved good OS and PFS for patients with FIGOⅠB2-ⅢB cervical cancer.Tumor diameter,age and postoperative lymph node status are important prognostic factors for survival.
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Objective To analyze the disease-free survival (DFS) and prognostic factors for stage Ⅰ_b cervical squamous cell carcinoma treated by radical hysterectomy. Methods From January 1999 to December 2005, a total of 206 patients with uterus cervical squamous cell carcinoma were retrospectively analyzed. All the patients were treated by type 3 hysterectomy and pelvic and/or para-aortic lymphadenectomy at Cancer Hospital, Chinese Academy of Medical Sciences. The diseases were stage Ⅰ_(B1) and Ⅰ_(B2)= in 103 patients each. Seventy-nine (76.7%) patients had preoperative radiotherapy and 111 (53. 9%) had postoperative adjuvant treatment (PosAT). Prognostic factors were analyzed using univariate model and multivariate Cox model. Results The follow-up rate was 92. 7%. 106 patients had following-up time of five years. The overall 5-year survival rate and the disease-free survival rate of stage Ⅰ_b,Ⅰ_(B1) and Ⅰ_(B2) were 96. 3% and 86. 8%, 100% and 94. 6%, 92. 2% and 77.9%, respectively. Univariate predictors of DFS included tumor size (FIGO stage, 77.9% : 94. 6% ; Χ~2 = 5. 58, P = 0. 018), lympho-vascular space involvement (LVSI, 74.6% : 89. 8% ; Χ~2 = 10. 44, P =0. 001), vaginal involvement (purely fornix involvement was not included disease, 50% : 87. 9% ; Χ~2 = 7.01,P = 0. 008), parametrial involvement (PI, Χ~2 = 17.69 ,P = 0. 000), and metastatic lymph nodes (LNM) > 2 (Χ~2 = 21.47, P = 0. 000) in stage Ⅰ_b disease, while LVSI (Χ~2 =6. 35,P =0. 012), PI (Χ~2 =90.00,P =0. 000) and LNM >2(Χ~2 =26. 27,P = 0. 000) in stage Ⅰ_(B1) disease, LVSI (Χ~2=10. 12,P =0. 001), cervical canal involvement (Χ~2 =4. 60,P = 0.032), vaginal involvement (Χ~2 =5.87,P=0.015), PI (Χ~2 =4.78,P=0.029) and LNM >2(Χ~2= 6. 72, P = 0. 010) in stage Ⅰ_(B2) disease. In multivariate analysis, FIGO stage (Χ~2 = 4. 73 ,P =0. 030), LVSI (Χ~2 = 9. 81, P = 0. 002), and LNM > 2 (Χ~2 = 6. 30, P = 0. 012) were significantly associated with DFS in stage Ⅰ_b, while LVSI (Χ~2 = 6. 38, P = O. 012) and LNM > 2 (Χ~2 = 3.92, P = 0. 048) were significantly associated with DFS in stage Ⅰ_(B2)-Conclusions LVSI is an important prognostic factor for stage Ⅰ_(B1) cervical cancer. PosAT reduces the recurrences in stage Ⅰ_(B2) desease. When PosAT is needed, preoperative radiotherapy can not improve DFS. PosAT should not be commonly used for stage Ⅰ_(B1) disease with only deep muscularis invasion.
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Objective To investigate the 5-and 10-year survival and complications of patients with stage Ⅱb cervical carcinoma treated by pre-operative photon radiotherapy (POPRT) plus brachytherapy (192Ir) and selective lymphadenectomy hysterectomy (SLH) plus intra-operative electron radiotherapy (IOERT). Methods From February 1997 to May 2007, 160 patients with stage Ⅱb cervical carcinoma were treated by POPRT of 20 Gy in 10 fractions to the whole pelvis, 192Ir brachytherapy of 14 Gy in 2fractions, followed by IOERT of 18 -20 Gy to the whole pelvis during SLH one week after. Results The follow-up rate was 98.1%. The number of patients followed-up for 5 and 10 years was 143 and 135,respectively. The 5-year overall survival rate, disease-free survival rate and local control rate of all patients were 89.4%, 86. 3% and 96. 3%, with the corresponding 10-year rates of 84.4%, 81.0% and 95.0%,respectively. The radiation-induced rectitis and cystitis were 5.0% and 0. 6%, respectivly. The rate of hydronephrosis and lower extremity edema was 6. 3% and 1.3%, respectively. Conclusions Combination of EBRT plus 192Ir brachytherapy and SLH plus IOERT could improve the survival and local control of patiens with cervical carcinoma, with only a few side effects.
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Objective To analyze the efficacy,late complications and prognostic factors of post-op-erative radiotherapy for cervical cancer. Methods From Nov. 1999 to Feb. 2005,114 patients with cervi-cal cancer received adjuvant pelvic radiotherapy after radical hysterectomy and pelvic lymphadenectomy. The median age was 42.5 (24 to 72) years old. According to the FIGO staging system,6,51,18,26 and 13 pa-tients had stage ⅠA, Ⅰb1, Ⅰb2, ⅡA and ⅡBdisease. The pathological type was squamous cell carcinoma,ade-nocarcinoma, squamous-adenocarcinoma and undifferentiated carcinoma in 92,19,2 and 1 patients, respec-tively. The whole-pelvic external beam irradiation of 50 Gy (40 to 60 Gy) was given with 6 MV or 15 MV X-ray beams using four-field box technique. Eighty-one patients received intravaginal brachytherapy of 16 Gy (4 -30 Gy in 1 -6 fractions) 4 weeks after the beginning of radiotherapy, with the referrence point being at 0.5 cm under the vaginal mucosa. Eighty-seven patients received preoperative and/or concurrent chemother-apy. The survival and independent prognostic factors were analyzed by Log-rank method and Cox model. Results The median follow-up time was 26.0 (5 - 75) months. The overall survival rate, disease-free sur-rival rate and local control rate were 93.1%, 88.1% and 94.6% at 2-year, and 75.7%, 62.3% and 85.6% at 5-year,respectively. The independent prognostic factors were lymph node metastasis and positive surgical margin for overall survival, positive surgical margin for local control, and stage, uterine body invasion and positive surgical margin for disease-free survival. Sixteen patients ( 14% ) had distant metastasis, and the most common sites were the lung,inguinal region,bone,liver and brain. According to RTOG grading sys-tem, the incidence of late gastrointestinal side effects of grade 1,2 and 3 was 11.4%, 11.4% and 3.5%. The corresponding genitourinary side effects were 14.0% ,6.1% and 0.9%, respectively. The incidence of leg lymphedema was 7 % . Conclusions Post - operative radiotherapy can achieve good local control in cervical cancer with acceptable late side effects. Distant metastasis is the main cause of death.
