Clinical Effect Investigation Of Adjuvant Chemotherapy In Patients With Intermediate Risk Factors After Radical Surgery In Early Stage Cervical Adenocarcinoma

Objective:The aim of this study was to compare the prognosis and side effects of adjuvant therapy for patients with intermediate risk factors in early stage cervical adenocarcinoma after radical surgery(radical hysterectomy and pelvic lymphadenectomy),and to analyze the clinical effect of adjuvant chemotherapy.Methods:This study retrospectively analyze patients in IB-IIA stage cervical adenocarcinoma,who are treated by the First Affiliated Hospital of Dalian Medical University、the Second Affiliated Hospital of Dalian Medical University and the Liaoning Cancer Hospital&Institute from January 2002 to December 2013.This study covers 65 cases of postoperative pathology confirmed with the intermediate risk factors of recurrence(cervical stromal invasion depth ≥ 1/2,lymph vascular space invasion and/or tumor the diameter of>4cm)and the clinical data were enrolled.The patients were divided into three groups:surgery group(9 cases without postoperative adjuvant therapy),adjuvant chemotherapy group(22 cases with adjuvant chemotherapy after operation)and adjuvant chemoradiotherapy group(including 8 cases of postoperative adjuvant radiotherapy and 26 cases adjuvant chemotherapy with radiotherapy,the total of 34 cases).The survival curve of three groups of patients with disease-free survival and overall survival was analysized by taking advantage of Kaplan-Meier method.In addition,log-rank test showed that there was statistical difference between the groups.Meanwhile,three groups of recurrence patterns and side effects were compared.Results:65 patients were followed up for a median of 64 months(range,26-158 months)with a mean age of 46 years(range,23-68 years).The adjuvant chemotherapy group,3 years and 5 years disease-free survival rate were 95.5%and 90.9%,the overall survival rate was 100%;2 patients with recurrence,1 case of distant ectopic ovarian recurrence and 1 case of vaginal stump recurrence,no patient died.The adjuvant chemoradiotherapy group,3 years and 5 years disease-free survival rate were 82.4%and 73.9%,3 years and 5 years overall survival rates were 88.2%and 75.8%respectively;8 cases of recurrence,5 cases of pelvic recurrence,distant metastasis in 3 cases,7 cases died.The surgery group,3 years and 5 years disease-free survival rate were 55.6%,3 years and 5 years overall survival rates were 88.9%and 61.0%respectively;4 cases of recurrence,1 case of distant metastasis and vaginal stump recurrence,1 case of lung metastasis,1 case of abdominal mass and 1 cases of pelvic mass,recurrent patients were died,including 1 patient were suicide.The disease-free survival and overall survival in the three groups were statistically significant different by analyzing of the results of log-rank test(p=0.041 and p=0.015).There was statistical difference in stage between the three groups,and there was no stage IIA cervical adenocarcinoma patient in the adjuvant chemotherapy group,so the subgroup of postoperative adjuvant chemotherapy and adjuvant chemoradiotherapy for patients with stage IB cervical adenocarcinoma were analyzed.The 3 years and 5 years disease-free survival in IB stage of adjuvant chemoradiotherapy(n = 23 cases)were 87.0%and 82.4%,respectively;the overall survival rates in the 3 years and 5 years were 91.3%and 86.7%,respectively.4 patients with recurrence and 3 patents were dead.There was no significant difference between the two groups in disease-free survival of patients with stage IB(p=0.428)and overall survival(p=0.0.085)from the log-rank test.There was no statistical difference in recurrence rate and recurrence patterns between the three groups.Adjuvant chemoradiotherapy group had more severe postoperative complications,such as III-IV degree bone marrow suppression,ureteral stricture and anal fistula.More importantly,the recurrent patients in the adjuvant chemotherapy group were all survived after treatment,while the patients in the chemoradiotherapy group most died after treatment,and the median survival time was 8.71±3.82 months.Conclusion:1.The disease-free survival and overall survival by adjuvant therapy can be improved for patients in stage ⅠB-ⅡA cervical adenocarcinoma who had the intermediate risk factors of recurrence after radical surgery.2.The clinical efficacy of patients in stage IB cervical adenocarcinoma who had the intermediate risk factors of recurrence after radical surgery was similar to the clinical efficacy after adjuvant chemotherapy alone and adjuvant chemoradiotherapy.However,the patients in adjuvant chemotherapy group had significantly less and less gentle complications than that in the adjuvant chemoradiotherapy.Adjuvant chemotherapy alone may be a better treatment.3.Chemotherapy did not change the recurrence patterns of patients in early cervical adenocarcinoma.4.The recurrent patients who have treated adjuvant chemotherapy alone may have better outcomes after rescue therapy.Further study is needed on this matter.