Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital)/Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences/Zhejiang Key Laboratory of Radiation Oncology/Department of Gynecological Radiation Oncology, Center for Uterine Cancer Diagnosis and Therapy Research of Zhejiang Province, Hangzhou 310022, China
AbstractObjective To evaluate the prognostic factors and the value of definitive pelvic radiotherapy in patients with stage ⅣB hematogenous metastatic cervical squamous cell carcinoma. Methods Clinical data of 80 patients with ⅣB stage squamous cell carcinoma admitted to Zhejiang Cancer Hospital from 2006 to 2016 were retrospectively analyzed. The survival analysis was conducted by Kaplan-Meier method. Prognostic factors were analyzed by Cox models. Results The 1-, 2-and 5-year overall survival (OS) and progression-free survival (PFS) rates were 52.5%, 26.3%, 16.8% and 25%, 13.8%, 8.8%, with a median OS of 13.8 months and a median PFS of 5.6 months, respectively. The most common site of metastasis was bone (51.3%), followed by lung (36.3%) and liver (26.3%). Univariate analysis revealed that chemotherapy combined with definitive pelvic radiotherapy and ≥6 cycles of chemotherapy were positively correlated with OS and PFS, whereas ECOG performance status score of 3-4 and liver metastasis were negatively correlated with OS and PFS. In multivariate analysis, liver metastasis (HR=2.23, 95%CI:1.01-4.91, P=0.048) and ECOG performance status score of 3-4(HR=2.01, 95%CI:1.03-3.91, P=0 0.040) were significantly correlated with poor OS. Subgroup multivariate analysis showed that compared with chemotherapy±palliative radiotherapy, systemic chemotherapy combined with definitive pelvic radiotherapy significantly improved OS (HR=0.39, 95%CI:0.18-0.84,P=0.016).compared with double drugs combined with<4 cycles of chemotherapy, double drugs in combination with ≥4 cycles of chemotherapy significantly improved OS (HR=0.32, 95%CI:0.15-0.68, P=0.003). Conclusions Patients with low ECOG performance status score or liver metastasis obtain poor prognosis. Definitive pelvic radiotherapy combined with chemotherapy can enhance clinical prognosis of patients with ⅣB stage hematogenous metastatic cervical squamous cell carcinoma.
Fund:Zhejiang Social Development Project of Public Welfare Technology Application (LGF19H160009);Joint Project built by Zhejiang Department (WKJ-ZJ-2020);Youth Talent Project of Zhejiang Provincial Department of Health (2018RC022);Surface Project of Zhejiang Provincial Department of Health (2020KY454)
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