| 1.Analysis of prognostic factors of patients with organ metastasis from newly diagnosed cervical cancerObjective: Our study aims to investigate the potential associations of the sites and the number of specific metastases with survival in patients newly diagnosed with cervical cancer.Methods: Medical records of patients with organ metastases of newly diagnosed cervical cancer in our Hospital from October 2006 to December 2016 were reviewed retrospectively.Survival times were compared using the Kaplan-Meier method.Variables associated with survival were identified using univariate and multivariate Cox proportional hazards models.Results: A total of 99 patients with newly diagnosed organ metastatic cervical cancer were identified.Median follow-up was 49.4 months(range,0.5–114.7 months).Median overall survival(OS)time was 11.7 months from diagnosis,median PFS was 5.6 months.The most common site of organ metastasis was bone(36.8%),followed by lung(32.8%)and liver(24%).In univariate analysis,oligometastasis,single organ metastasis,bone metastasis and chemotherapy combined with local treatment were positively correlated with survival time,while liver metastasis was negatively correlated with survival time.In multivariate analysis,liver metastasis(hazard ratio [HR]=4.02;95% confidence interval [CI],1.15-14.05,P=0.029)was significantly and independently related to poor OS and PFS rates,while chemotherapy+local treatment(HR=0.40;95%CI,0.19-0.82,P=0.012)was significantly and independently related to improved OS and PFS rates.Conclusion: Our data revealed liver metastasis signifying particularly poor overall survival and as an independent factor,affects the overall survival of patients.Chemotherapy combined with individualized local treatments may improve the survival of patients.2.Efficacy of radical doses of pelvic radiotherapy for primary tumor treatment in patients with newly diagnosed organ metastatic cervical cancerObjective: The clinical efficacy of definitive pelvic radiotherapy for primary tumors in patients with newly diagnosed organ metastatic cervical cancer is unclear.Therefore,we conducted a retrospective study to evaluate the efficacy of definitive pelvic radiotherapy combined with systemic chemotherapy in patients with organ metastatic cervical cancer.Methods: We retrospectively analysed medical records from patients with newly diagnosed organ metastatic cervical cancer,all treated with chemotherapy in our Hospital between October 2006 and December 2016.Survival times were compared using the Kaplan-Meier method.The univariate log-rank method and multivariate Cox proportional hazard models were used to identify associated variables with survival.Results: A total of 48 patients were identified from 11,982 primary cervical cancer patients and divided into two groups according to treatment mode: 36 patients received chemotherapy combined with definitive pelvic radiotherapy(group A),12 patients underwent chemotherapy with/without palliative pelvic radiotherapy(group B).Median follow-up was 44.0 months(range,4.6–114.7 months).Median overall survival(OS)for the whole group,group A and group B was 14.8,17.3 and 10 months,respectively.Using the univariate analysis,group A was found to have a better OS than group B(P=0.002).In multivariate analysis,group A(hazard ratio [HR],0.32;95% confidence interval [CI],0.15–0.67,P=0.003)was associated with lower risk of death compared with group B.The main reason for treatment failure was found to be due to the progression of distant metastatic lesions in 36 patients(75%)from the whole cohort.Conclusion: In this cohort of organ metastatic cervical cancer patients,chemotherapy combined with definitive pelvic radiotherapy was associated with improved survival outcomes when compared with chemotherapy with/without palliative pelvic radiotherapy.Prospective trials evaluating definitive pelvic radiotherapy for newly diagnosed organ metastatic cervical cancer,therefore,are warranted.3.Definitive pelvic radiotherapy combined with chemotherapy for stage ?B cervical cancer: a prospective,single-arm,phase 2 trial.Objective: The significance and value of definitive radiotherapy pelvic radiotherapy for stage ?B cervical cancer is not clear.We hope to explore the role of pelvic definitive radiotherapy in the comprehensive treatment of ?B stage cervical cancer through prospective clinical trial.Methods: This is a prospective,single-arm,phase 2 clinical trial.Patients with stage ?B cervical cancer who diagnosed and treated in our hospital were enrolled between January 2017 and December 2019.The clinical data,treatment and prognosis were recorded.Survival times were compared using the Kaplan-Meier method.The univariate log-rank method and multivariate Cox proportional hazard models were used to identify associated variables with survival.Chi-square test and Fisher's exact test were used to compare the two rates of clinical pathological factors..Results: A total of 41 pts met inclusion and exclusion criteria,including 20 patients with hematogenous metastasis and 21 patients with lymphatic metastasis.The median follow-up time was 24.9 months(5.6-41.1 months);the median overall survival time was 26.5 months,the 1-year and 2-year overall survival rates were 88% and 55% respectively;the median progression free survival time was 16.5 months,and the 1-year and 2-year progression free survival rates were 64.2% respectively The median overall survival time was 26.5 months and 24.1 months,respectively,with a 2-year overall survival rate of 44.9% and 28.8%,respectively(P=0.881).All patients received 4-6 cycles of combined chemotherapy and pelvic radical radiotherapy.Multivariate analysis showed that chemotherapy cycle(6 weeks vs.4-5 cycles)was an independent prognostic factor(hazard ratio [HR] = 0.25;95% confidence interval [CI],0.07-0.91,P= 0.035).Whether the serum tumor markers can return to normal is an independent prognostic factor(hazard ratio [HR] = 0.25;95% confidence interval [CI],0.08-0.83,P=0.024).The grade 3-4 incidence of neutropenia,anemia and thrombocytopenia in the whole group were 78%,61.0% and 39.0%,respectively.The incidence of grade 3-4 leukopenia in the extension field and whole pelvic field was 92% and 31.3%(P < 0.001);The incidence of grade 3-4 thrombocytopenia in the extension field and whole pelvic field was 56% and 12.5% (P=0.008);all of these indicating that the larger the radiation field,the more obvious the decrease of leukocyte and thrombocytopenia.20 patients(48.8%)relapsed,17 patients(85%)relapsed outside of radiation field.Conclusion: Compared with the historical data of chemotherapy alone,the survival data of the patients in this group showed a longer total survival period,suggesting that definitive pelvic radiotherapy plays an important role in the treatment of ?B stage cervical cancer.Compared with 4-5 cycles of chemotherapy,6 cycles of systemic chemotherapy means an improvement in the overall survival rate,therefore,6 cycles of combined chemotherapy is recommended.Whether the serum tumor markers can return to normal after radiotherapy and chemotherapy is related to the risk of patients' progress,which suggests that the serum tumor markers can be used as one of the therapeutic evaluation indexes.The increase of radiation field volume may increase hematologic toxicity.To explore more effective systemic and local treatment mode is the direction of future research. |
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