Objectives: In patients undergoing a radical hysterectomy, uterine corpus invasion worsens cervical cancer prognosis. However, the prognostic role of the invasion in locally advanced stages remains elusive. Due to the inadequacy of typical corpus biopsies, corpus invasion is diagnosed using magnetic resonance imaging (MRI). In this study, we investigated the prognostic role of MRI-detected uterine corpus invasion in patients undergoing radiotherapy for cervical cancer. Methods: This retrospective analysis involved 259 patients without extrapelvic metastases, diagnosed with FIGO 2009 stages IB–IVA cervical carcinoma from January 2011 to December 2020. The corpus invasion extent was classified as exocervical-confined (group 1), endocervical (group 2), or uterine corpus invasion (group 3). The rates of overall survival, cancer-specific survival, locoregional recurrence, para-aortic lymph node recurrence, and extrapelvic metastases after pelvic radiotherapy were analyzed. Kaplan–Meier and Cox regression analyses were used to determine recurrence-associated risks. Optimal risk stratification was predicted using a receiver operating characteristic curve with the area under the curve. Results: Groups 1, 2, and 3 included 66.0%, 18.9%, and 15.1% of patients, respectively. The 5-year para-aortic lymph node recurrence rates were 6.3%, 17.2%, and 34.2% (p< 0.001). Uterine corpus invasion was an independent factor for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence. Including uterine corpus invasion in the risk stratification led to higher areas under the curve for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence than using single parameters. Conclusions: In cervical cancer, following pelvic radiotherapy, uterine corpus invasion is a significant prognostic factor. More-aggressive treatments such as extended-field radiotherapy, adjuvant chemotherapy, and immune checkpoint inhibitors as an alternative to standard pelvic radiotherapy with concurrent chemotherapy may be considered in these patients.
目的：在接受根治性子宫切除术的患者中，子宫体侵犯会恶化宫颈癌的预后。然而，在局部晚期阶段，子宫体侵犯的预后作用仍不明确。由于常规子宫体活检的不足，子宫体侵犯通常通过磁共振成像（MRI）进行诊断。本研究旨在探讨MRI检测到的子宫体侵犯在接受放疗的宫颈癌患者中的预后作用。方法：这项回顾性分析纳入了2011年1月至2020年12月期间诊断为FIGO 2009分期IB至IVA期宫颈癌、无盆腔外转移的259例患者。根据侵犯范围将患者分为三组：宫颈外局限（第1组）、宫颈内侵犯（第2组）和子宫体侵犯（第3组）。分析各组患者在接受盆腔放疗后的总生存率、癌症特异性生存率、局部区域复发率、腹主动脉旁淋巴结复发率以及盆腔外转移率。采用Kaplan-Meier法和Cox回归分析确定复发相关风险，并通过受试者工作特征曲线下面积预测最佳风险分层。结果：第1、2、3组患者分别占66.0%、18.9%和15.1%。三组患者的5年腹主动脉旁淋巴结复发率分别为6.3%、17.2%和34.2%（p<0.001）。子宫体侵犯是总生存率、癌症特异性生存率、局部区域复发、盆腔外转移及腹主动脉旁淋巴结复发的独立影响因素。在风险分层中纳入子宫体侵犯后，总生存率、癌症特异性生存率、局部区域复发、盆腔外转移及腹主动脉旁淋巴结复发的曲线下面积均高于使用单一参数时的结果。结论：在宫颈癌患者接受盆腔放疗后，子宫体侵犯是一个重要的预后因素。对于存在子宫体侵犯的患者，可考虑采用更积极的治疗方案，如扩大野放疗、辅助化疗以及免疫检查点抑制剂，以替代标准的盆腔放疗联合同步化疗。
肿瘤(癌症)患者之家