局部晚期鳞状细胞外阴癌术前化疗后手术：术后结局和生存分析

Surgery after upfront chemoradiation in locally advanced squamous cell vulvar cancer: Analysis of postoperative outcomes and survival

GYNECOLOGIC ONCOLOGY

影响因子:4.1

分区:医学2区 Top / 妇产科学1区肿瘤学2区

发表日期:2024 Dec

作者: Alex Federico, Valentina Lancellotta, Simona M Fragomeni, Gabriella Macchia, Sara Ammar, Tina Pasciuto, Angela Santoro, Giacomo Corrado, Alessia Piermattei, Valerio Gallotta, Luca Tagliaferri, Gianfranco Zannoni, Maria A Gambacorta, Giovanni Scambia, Giorgia Garganese

DOI: 10.1016/j.ygyno.2024.10.005

摘要

本研究旨在评估在接受前置化疗（CRT）±手术治疗的局部晚期鳞状细胞外阴癌（LAVC）患者中的生存率及手术相关毒性。CRT是不可切除的局部晚期鳞状细胞外阴癌的主要治疗方式，若有残留肿瘤，则随后进行手术。2016年1月至2023年2月，来自Fondazione Policlinico Universitario Agostino Gemelli I.R.C.C.S.妇科肿瘤科的符合条件的63例患者接受了前置CRT治疗，其中21例（33%）完全缓解（cCR），26例（41%）部分缓解（cPR），1例（2%）疾病稳定（cSD），15例（24%）疾病进展（cPD）。在整体人群中，cPR/SD及cPD组的无进展生存期（PFS）和总生存期（OS）显著较短（p<0.001），p16表达与改善PFS（p<0.001）及OS（p=0.001）相关。在CRT后有临床残余疾病的患者中，接受手术的23例患者比接受其他治疗的患者表现出更长的PFS（p=0.003）和OS（p=0.003）。有8例（35%）患者出现严重（≥III级）术后并发症，最常见的并发症为外阴和腹股沟伤口裂开/感染；其中一例（4%）患者在术后死亡。具有病理残余疾病的患者表现出较差的PFS（p=0.013）和OS（p=0.034）。CRT的临床反应和p16表达是预测LAVC患者生存的重要指标。残余疾病的手术治疗可能改善生存，但伴随较高的并发症发生率。病理残余疾病与高复发率和预后不良密切相关。

Abstract

The aim of the study was to assess the survival rates and surgery-related toxicity in patients with locally advanced squamous cell vulvar cancer (LAVC) managed by upfront chemoradiation (CRT) with/without following by surgery. CRT is the primary treatment for patients with unresectable locally advanced squamous cell vulvar carcinoma (LAVC), followed by surgery in case of residual tumor.Patients with AJCC stage II-IV squamous cell vulvar carcinoma referred to Gynecologic Oncology Unit at Fondazione Policlinico Universitario Agostino Gemelli I.R.C.C.S. from January 2016 to February 2023, managed by upfront CRT, were included.63 patients were included, 21 (33 %) had complete response (cCR) to CRT, 26 (41 %) had partial response (cPR), 1 (2 %) stable disease (cSD), 15 (24 %) had disease progression (cPD). In the whole population, cPR/SD and cPD were associated with reduced PFS (p < 0.001) and overall survival (OS) (p < 0.001), p16 expression was associated with improved PFS (p < 0.001) and OS (p = 0.001). Among patients with clinical residual disease after CRT, 23 patients undergoing surgery experienced improved PFS (p = 0.003) and OS (p = 0.003) compared to those receiving other treatments. Eight (35 %) patients experienced severe (grade ≥ III) postoperative complications; vulvar and groin wound dehiscence/infection were the most common complications; one (4 %) patient died in the postoperative. Patients with pathological residual disease experienced worse PFS (p = 0.013) and OS (p = 0.034).Clinical response to CRT and p16 expression strongly predict survival in LAVC. Surgery for residual disease might be associated with improved survival but is burdened by high rates of complications. Pathologic residual disease correlates with high recurrence rates and poor survival.