文章：

“中危”早期宫颈癌的辅助治疗：治疗与否？系统综述与荟萃分析

Adjuvant Therapy in “Intermediate-Risk” Early-Stage Cervical Cancer: To Treat or Not to Treat? Systematic Review and Meta-Analysis

原文发布日期：14 April 2025

DOI: 10.3390/cancers17081320

类型: Article

开放获取: 是

英文摘要：

International guidelines do not take a clear position regarding the management of patients with “intermediate-risk” cervical cancer, and they remain noncommittal on the necessity of adjuvant therapy following radical hysterectomy. To determine if adjuvant therapy after surgery adds benefit in “intermediate-risk” cervical cancer patients in terms of recurrence rate and mortality rate, we performed a systematic review with meta-analysis on Google Scholar, PubMed, and Scopus. The inclusion criteria were studies with >100 patients with intermediate-risk cervical cancer according to the Sedlis criteria, RCTs, or propensity score-matched cohort studies reporting oncological outcomes and treatment-related toxicity, comparing a surgery-only cohort with an adjuvant therapy cohort. We found 11 studies that met our inclusion criteria, comprising a total of 4011 patients. The mean follow-up was 80.7 months. No statistically significant differences were found for both outcomes, respectively, recurrence rate OR 0.92 (95% CI 0.70–1.20, I238%) and mortality rate OR 1.05 (95% CI 0.77–1.46, I241%). However, a statistically significant difference was found in the site of recurrence–pelvic OR 0.48 (95% CI 0.23–0.98,p< 0.001, I242%) or distant OR 2.10 (95% CI 1.02–4.33,p< 0.001 I242%). Treatment-related risk of Grade 3 or 4 toxicity was statistically significant. Our meta-analysis shows that oncological outcomes in this class of patients are similar between the two groups. However, while awaiting the results of new RCTs, it is crucial to define a personalized diagnostic and therapeutic strategy for each patient.

摘要翻译： 

国际指南对于“中危”宫颈癌患者的治疗未明确表态，对根治性子宫切除术后辅助治疗的必要性仍持保留态度。为评估术后辅助治疗能否降低中危宫颈癌患者的复发率和死亡率，我们在Google Scholar、PubMed和Scopus数据库中对相关文献进行了系统综述与荟萃分析。纳入标准为：符合Sedlis标准的中危宫颈癌患者数>100例的研究、随机对照试验或倾向评分匹配队列研究，需报告肿瘤学结局及治疗相关毒性，并设置单纯手术组与辅助治疗组的比较。最终纳入11项符合标准的研究，共4011例患者，平均随访时间80.7个月。两组在复发率（OR 0.92，95% CI 0.70–1.20，I²=38%）和死亡率（OR 1.05，95% CI 0.77–1.46，I²=41%）方面均未发现统计学显著差异。但复发部位存在显著差异：盆腔复发（OR 0.48，95% CI 0.23–0.98，p<0.001，I²=42%）与远处转移（OR 2.10，95% CI 1.02–4.33，p<0.001，I²=42%）。治疗相关的3-4级毒性风险具有统计学显著性。本荟萃分析表明，该类患者的肿瘤学结局在两组间无显著差异。然而，在等待新随机对照试验结果的同时，为每位患者制定个体化诊疗策略至关重要。

原文链接：

Adjuvant Therapy in “Intermediate-Risk” Early-Stage Cervical Cancer: To Treat or Not to Treat? Systematic Review and Meta-Analysis