【摘要】 目的对比子宫颈癌FIGO 2018新分期ⅡA1期患者不同治疗方法的肿瘤学结局,探讨2018年FIGO新分期下ⅡA1期子宫颈癌的治疗策略。方法基于中国子宫颈癌临床诊疗项目大数据库(1538项目数据库),分别纳入接受直接开腹手术(ARH组)、术前新辅助化疗后手术(NACT组)和根治性放化疗(R-CT组)治疗的FIGO 2018ⅡA1期子宫颈癌患者,比较3种治疗方法的5年总体生存率(OS)和无病生存率(DFS)。结果 (1)基于1538项目数据库,共纳入FIGO 2018ⅡA1期子宫颈癌1724例,包括ARH组(n=1308)、NACT组(n=193)和R-CT组(n=223),中位随访时间为45个月(ARH组48个月,NACT组43个月,R-CT组31个月)。(2)在整体队列中对3组进行生存分析显示,3组之间总体的5年OS和DFS差异有统计学意义(P<0.001)。其中ARH组5年OS和DFS虽均优于NACT组,但差异无统计学意义(OS:92.5%vs. 89.6%,P=0.073;DFS:87.9%vs. 87.7%,P=0.562);R-CT组的5年OS和DFS均较ARH组(OS:80.9%vs. 92.5%,P<0.001;DFS:74.4%vs. 87.9%,P<0.001)和NACT组(OS:80.9%vs. 89.6%,P=0.04;DFS:74.4%vs. 87.7%,P=0.003)差。(3)Cox回归分析显示,相较于ARH,R-CT是ⅡA1期子宫颈癌患者死亡和复发/死亡的独立危险因素(OS:HR=1.675,95%CI 1.342～2.091,P<0.001;DFS:HR=1.537,95%CI1.286～1.837,P<0.001),ARH和NACT之间的死亡和复发/死亡风险均差异无统计学意义(OS:HR=1.713,95%CI0.994～2.953,P=0.053;DFS:HR=1.118,95%CI 0.697～1.793,P=0.645)。结论初始治疗为ARH和NACT可使FIGO 2018ⅡA1期子宫颈癌患者预后获益最大,R-CT不利于其肿瘤学预后,从卫生经济学角度ARH是ⅡA1期子宫颈癌患者的首选治疗方法。更多还原

【Abstract】 Objective To compare the oncological outcomes of different treatment methods for patients with FIGO 2018 new stage Ⅱ A1 cervical cancer,and to explore the treatment strategy for FIGO 2018 new stage ⅡA1 cervical cancer.Methods based on the Chinese cervical cancer clinical diagnosis and treatment project database(1538 project database),the patients with FIGO2018 Ⅱ A1 cervical cancer treated with direct laparotomy(ARH group),surgery after preoperative neoadjuvant chemotherapy,(NACT group) and radical chemoradiotherapy(R-CT group)were included respectively.The 5-year OS and DFS of the three treatment methods were compared.Results(1)Based on the 1538 project database,1724 cases of FIGO 2018 Ⅱ A1 cervical cancer were included,including ARH group(n=1308),NACT group(n=193)and R-CT group(n=223).The median follow-up time was 45 months(48 months in ARH group,43 months in NACT group and 31 months in R-CT group).(2)Survival analysis of the three groups in the overall cohort showed that there were significant differences in overall 5-year OS and DFS among the three groups(P<0.001).Although the 5-year OS and DFS in ARH group were better than those in NACT group,the difference was not statistically significant(OS:92.5% vs.89.6%,P=0.073;DFS:87.9% vs.87.7%,P=0.562).The 5-year OS and DFS in R-CT group were higher than those in ARH group(OS:80.9% vs.92.5%,P<0.001;DFS:74.4% vs.87.9%,P<0.001)and NACT group(OS:80.9% vs.89.6%,P=0.04;DFS:74.4% vs.87.7%,P=0.003).(3)Cox multivariate analysis showed that compared with ARH R-CT was an independent risk factor for death and recurrence/death in patients with stage ⅡA1 cervical cancer(OS:HR=1.675,95%CI 1.342-2.091,P<0.001;DFS:HR=1.537,95%CI 1.286-1.837,P<0.001).There was no difference in the risk of death or recurrence/death between ARH and NACT(OS:HR=1.713,95% CI 0.994-2.953,P=0.053;DFS:HR=1.118,95% CI 0.697-1.793,P=0.645).Conclusion The initial treatment with ARH and NACT can result in the best prognosis of patients with FIGO 2018 stage ⅡA1 cervical cancer,and R-CT is not conducive to their oncological prognosis.From the perspective of health economics,ARH is the preferred treatment for stage ⅡA1 cervical cancer.更多还原