Objective:This study aims to explore the benefit of adjuvant chemoradiotherapy compared with radiotherapy alone following a radical hysterectomy with pelvic lymphadenectomy. The study focuses on patients with clinically early-stage squamous cervical cancer who have a single high-risk factor postoperatively.Methods:This retrospective study included women diagnosed between 2001 and 2018, with: (1) clinical tumour (cT) stage 1A2–2A2, (2) cervical squamous carcinoma, (3) treated with radical hysterectomy and pelvic lymphadenectomy (4) followed by adjuvant (chemo)radiotherapy, and with (5) one high-risk factor (i.e., positive resection margins, parametrial involvement, or pelvic lymph node metastases). Recurrence-free and overall survival were estimated using Kaplan−Meier and Cox proportional hazards analyses. Inverse probability treatment weighting was used to adjust for confounding.Results:Of the 122 patients with squamous cell carcinoma and one high-risk factor, 76 (62%) received adjuvant chemoradiotherapy and 46 (38%) received adjuvant radiotherapy alone. Larger tumour size, tumour grade 3, and pathological parametrial invasion were more common in the radiotherapy group, while patients who received chemoradiotherapy were more likely to have multiple lymph node metastases. The unadjusted and for confounding adjusted 5-year survival rates were comparable between the adjuvant chemoradiotherapy and radiotherapy groups for both recurrence-free survival (85% versus 87%;p= 0.58, and 84% versus 91%;p= 0.49) and overall survival (84% versus 87%;p= 0.51, and 84% versus 91%;p= 0.49).Conclusions:Adding chemotherapy to radiotherapy may not improve survival of patients with early squamous cervical cancer treated with radical hysterectomy and pelvic lymphadenectomy, and with a single postoperative high-risk factor.
目的：本研究旨在探讨根治性子宫切除联合盆腔淋巴结清扫术后，辅助放化疗与单纯放疗相比的获益。研究聚焦于术后仅存在单一高危因素的临床早期宫颈鳞癌患者。 方法：本回顾性研究纳入2001年至2018年间诊断的女性患者，纳入标准为：(1) 临床肿瘤(cT)分期为1A2–2A2期，(2) 宫颈鳞状细胞癌，(3) 接受根治性子宫切除及盆腔淋巴结清扫术，(4) 术后接受辅助（放）化疗，且(5) 仅存在一种高危因素（即切缘阳性、宫旁浸润或盆腔淋巴结转移）。采用Kaplan−Meier法和Cox比例风险模型评估无复发生存期和总生存期。使用逆概率处理加权法校正混杂因素。 结果：在122例具有单一高危因素的鳞状细胞癌患者中，76例（62%）接受了辅助放化疗，46例（38%）仅接受了辅助放疗。放疗组中肿瘤体积较大、肿瘤分级为3级以及病理学宫旁浸润更为常见，而接受放化疗的患者更可能有多发淋巴结转移。在未校正和校正混杂因素后，辅助放化疗组与单纯放疗组的5年生存率均无显著差异，无论是无复发生存率（85% 对 87%；p=0.58，以及84% 对 91%；p=0.49）还是总生存率（84% 对 87%；p=0.51，以及84% 对 91%；p=0.49）。 结论：对于接受根治性子宫切除及盆腔淋巴结清扫术、且术后仅存在单一高危因素的早期宫颈鳞癌患者，在放疗基础上加用化疗可能无法改善其生存。
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