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【文献翻译】术前放疗或放化疗对宫颈癌术后病理结果的影响——基于中国46313例宫颈癌患者的大型数据库

目的

1

本研究旨在探讨术前辅助放疗或放化疗联合根治性手术对宫颈癌患者病理结果的影响。

To investigate the effect of preoperative radiotherapy or chemoradiotherapy combined with radical surgery on pathological outcomes in cervical cancer patients.

方法

2

基于中国宫颈癌临床诊断和治疗的一个大型数据库(C4项目),本研究对比了术前辅助放疗或放化疗组(PR组)和单纯手术组(SD组)宫颈癌术后的病理结果。

Based on a large Chinese cervical cancer database of clinical diagnosis and treatment (C4 Project), the postoperative pathological outcomes of patients who received preoperative radiotherapy or chemoradiotherapy followed by open surgery (PR group) or surgery alone (SD group) were compared.

结果

3

在经过严格筛选入组的病人中,对比发现:术前放(化)疗组(PR)(n=574)的淋巴结转移发生率高于单纯手术组(SD)(231 VS 9; P < 0.001),但PR组血管间隙浸润的发病率低于SD组(72 VS 2041; P < 0.001)。Logistic 回归分析显示术前放疗对于宫旁受累、手术切缘阳性、宫颈间质深部浸润和血管间隙浸润是一个保护因素(P < 0.05)。两组中切除的淋巴结的中位数为18。在经过1:1病例匹配后,术前放疗组的宫颈间质深部浸润和血管间隙浸润的发生率低于直接手术组(分别292 vs 376, P < 0.001; 60 vs 106, P < 0.001)。Logistic回归分析表明术前放疗对于宫颈间质深部浸润和血管间隙浸润是一个保护因素(P < 0.05)。匹配后两组中切除的淋巴结的中位数分别为18和19。

Among the strictly selected patients, the incidence of lymph node metastasis in the PR group (n = 574) was higher than that in the SD group (231 VS 9; P < 0.001), while the incidence of vascular space invasion was lower than that in the SD group (72 VS 2041; P < 0.001). The logistic regression analysis showed that preoperative radiotherapy was a protective factor for parametrial involvement, positive surgical margins, deep cervical stromal invasion, and vascular space invasion (P < 0.05). The median number of resected lymph nodes in both groups was 18. After 1:1 case matching, the incidence of deep cervical stromal invasion and vascular space invasion was reduced by preoperative radiotherapy (292 vs 376, P < 0.001; 60 vs 106, P < 0.001). Logistic regression analysis indicated that preoperative radiotherapy was a protective factor for deep cervical stromal invasion and vascular space invasion (P < 0.05). The median numbers of resected lymph nodes in the two groups were 18 and 19, separately.

结论

4

术前放疗可以降低宫颈间质深部浸润和血管间隙浸润的发生率,但它不能降低淋巴结阳性、宫旁受累和手术切缘阳性的发生率。

Preoperative radiotherapy can reduce both the incidence of deep cervical stromal invasion and vascular space invasion, but it cannot reduce lymph node positivity, parametrial involvement and positive surgical margins.

参考文献

Weili Li , Ping Liu , Weidong Zhao, et al. Effects of Preoperative Radiotherapy or Chemoradiotherapy on Postoperative Pathological Outcome of Cervical Cancer--From the Large Database of 46,313 Cases of Cervical Cancer in China. Eur J Surg Oncol. 2019 Oct 7.[Online ahead of print]

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撰稿 | 张蕊

编辑 | 庞智屿

责任编辑 | 刘雨奇

审稿 | 江路

审核 | 陶霞

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