Significance Of Postoperative Chemotherapy In Adjuvant Therapy Of Cervical Cancer

Objective:To analyze and compare the difference and influencing factors of oncology outcome between postoperative adjuvant chemotherapy and other treatments in patients with cervical cancer of ⅠA1(LVSI+)～ⅡB stage in FIG02009 stage,and to explore the application prospect of postoperative adjuvant chemotherapy for cervical cancer and to provide reliable clinical data.Methods:In the Clinical Diagnosis and treatment for Cervical Cancer in China(Four C)database,cases of cervical cancer without preoperative adjuvant therapy were selected.FIGO 2009 ⅠA1(LVSI+)～ⅡB cervical cancer patients who received postoperative adjuvant therapy from 2004 to 2018 were selected.By using the method of overall study population and propensity score matching,retrospective analysis of 5-year OS and DFS of postoperative adjuvant chemotherapy and no adjuvant therapy,adjuvant radiotherapy(simultaneous radiotherapy and chemotherapy)and sequential therapy,and to further explore the 5-year OS and DFS of different adjuvant chemotherapy regimens and different chemotherapy cycles after operation.Results:1.In China,51%of postoperative patients with cervical cancer received various adjuvant treatments,of which 20%were treated with standard treatment,26.1%with undertreatment and 20.4%with overtreatment.From the application level of overall adjuvant therapy,Chemotherapy is relatively common in China.Postoperative adjuvant chemotherapy is the most widely used in first-tier cities;In general hospitals and maternal and child hospitals,postoperative adjuvant chemotherapy is the most common;In those without any risk factor or a moderate risk factor after operation,there is no adjuvant therapy after operation,and adjuvant chemotherapy is the second choice;Among those who combine high risk factors or 2 or more medium risk factors,after operation,sequential therapy is the main treatment,followed by adjuvant chemotherapy.In a variety of adjuvant chemotherapy regimens,the application of platinum+taxol plays a leading role.And receive 1-6 more cycles of chemotherapy.2.Adjuvant therapy for different pathological types:In patients with squamous cell carcinoma,the 5-year OS and DFS of adjuvant radiotherapy(simultaneous radiotherapy and chemotherapy)and sequential therapy are superior to adjuvant chemotherapy,and the 5-year OS of radiotherapy(simultaneous radiotherapy and chemotherapy)is better than that of sequential therapy;In patients with adenocarcinoma and adenosquamous carcinoma,there was no significant difference in 5-year OS and DFS among the three adjuvant treatments(adjuvant chemotherapy,adjuvant radiotherapy and sequential therapy).3.Adjuvant therapy for different risk factors:In patients with no risk factor or one moderate risk factor,there was no significant difference in 5-year OS and DFS between three kinds of adjuvant therapy and no treatment;In patients with no risk factor,there was no significant difference in 5-year OS and DFS between three kinds of adjuvant therapy and no treatment;In patients with any high risk or 2 or more moderate risks,the 5-year OS and DFS of postoperative adjuvant radiotherapy(simultaneous radiotherapy and chemotherapy)and sequential therapy is better than that of adjuvant chemotherapy.4.Among the patients with postoperative adjuvant chemotherapy,the DFS who received platinum+paclitaxel chemotherapy was better than those who did not use this regimen.There was no significant difference in 5-year OS between platinum+paclitaxel and non-(platinum+paclitaxel)chemotherapy regimens.And the oncology outcome of 4 courses of chemotherapy is the best.Conclusions:1.There is a diversity of adjuvant therapy for patients with cervical cancer in China.Adjuvant chemotherapy is widely used.Platinum+paclitaxel chemotherapy is still the first choice for postoperative adjuvant chemotherapy for patients with cervical cancer.And mainly with 1-6 courses of treatment.2.Adjuvant radiotherapy(simultaneous radiotherapy and chemotherapy)is the first choice for patients with cervical squamous cell carcinoma who need to be treated after operation.For patients with cervical adenocarcinoma/adenosquamous carcinoma who need to be treated after operation,the efficacy of postoperative chemotherapy alone is similar to that of adjuvant radiotherapy(simultaneous radiotherapy and chemotherapy)and sequential therapy.Considering the side effects of radiotherapy,adjuvant chemotherapy can be chosen.3.Overtreatment is not recommended for patients without any risk factor or a moderate risk factor after operation.Adjuvant radiotherapy(simultaneous radiotherapy and chemotherapy)and sequential therapy are the first choice for postoperative patients with high risk factors or 2 or more medium risk factors.4.For postoperative patients receiving adjuvant chemotherapy,four courses of platinum+paclitaxel chemotherapy are recommended.