Initial treatment for FIGO 2018 stage IIIC cervical cancer based on histological type: A 14-year multicenter study

作者：Ye, Yanna; Zhang, Guozhao; Li, Zhiqiang; Chen, Biliang; Zhao, Hongwei; Yang, Ying; Wang, Li; Yao, Jilong; Chen, Xiaolin; Huang, Yahong; Lang, Jinghe; Liu, Ping^*; Chen, Chunlin^*

来源：Cancer Medicine, 2023, 12(19): 19617-19632.

DOI：10.1002/cam4.6586

• adenocarcinoma/adenosquamous cell carcinoma
• cervical cancer
• cervical cancer treatment
• squamous cell carcinoma
• stage IIIC cervical cancer

Background: To compare the oncological outcomes of radical chemotherapy (R-CT), abdominal radical hysterectomy (ARH), and neoadjuvant chemotherapy and radical surgery (NACT) for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC cervical cancer, according to histological types: squamous cell carcinoma (SCC) and adenocarcinoma (AC)/adenosquamous cell carcinoma (ASC).Methods: A comparison of 5-year overall survival (OS) and disease-free survival (DFS) was performed for the SCC and AC/ASC subgroups for the three initial treatments, assessed using Kaplan-Meier and Cox proportional hazards regression analysis and validated using propensity score matching (PSM).Results: The study included 4086 patients: R-CT, n = 1913; ARH, n = 1529; and NACT, n = 644. AC/ASC had a lower survival rate (63.7%) than SCC (73.6%) and a higher recurrence and mortality rate (36.3% and 26.4%, respectively). The 5-year OS and DFS rates were different in the SCC group for R-CT, ARH, and NACT (OS: 69.8% vs. 80.8% vs. 73.0%, p < 0.001; DFS: 66.7% vs. 70.7% vs. 56.4%, p < 0.001), also in the AC/ASC group (OS: 46.1% vs. 70.6% vs. 55.6%, p < 0.001; DFS: 42.7% vs. 64.6% vs. 40.8%, p < 0.001). As for initial treatment, survival outcomes were worse for AC/ASC treated with R-CT and ARH than for SCC (both p < 0.05), with no group differences between the two treated with NACT.Conclusion: Initial treatment influences oncological prognosis for patients with FIGO 2018 stage IIIC cervical cancer. ARH is an alternative treatment for stage IIIC cervical SCC and AC/ASC, and NACT needs to be chosen with caution, moreover, R-CT for AC/ASC requires careful selection.

• 单位
  南方医科大学; 东莞理工学院; 郑州大学; 中国医学科学院北京协和医院