局部晚期鳞状细胞外阴癌的预化化疗后手术：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
影响因子:4.10000
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
摘要
该研究的目的是评估由前期化学放疗（CRT）管理的局部晚期鳞状细胞癌（LAVC）患者的生存率和与手术有关的毒性，并没有进行手术。 CRT是针对患有局部晚期鳞状细胞外阴癌（LAVC）患者的主要治疗方法，然后进行手术，以防万一残留肿瘤。从2016年1月到2023年2月，包括前期CRT管理的。包括63例患者，21例（33％）对CRT具有完全反应（CCR），26（41％）具有部分反应（CPR），1（2％）稳定疾病（CSD）（CSD），15（CSD），15（24％）患有疾病进展（CPD）。在整个人群中，CPR/SD和CPD与PFS降低（P <0.001）和总生存期（OS）（P <0.001）有关，P16表达与改善的PFS（P <0.001）和OS（P = 0.001）有关。在CRT后临床残留疾病的患者中，与接受其他治疗的患者相比，23例接受手术的患者的PFS（P = 0.003）和OS（P = 0.003）得到了改善（P = 0.003）。八名（35％）患者经历了严重的（≥III级）术后并发症；外阴和腹股沟伤口/感染是最常见的并发症。一名（4％）患者在术后死亡。病理残留疾病的患者的PFS较差（P = 0.013）和OS（P = 0.034）。对CRT和P16表达的临床反应强烈预测LAVC中的生存。残留疾病的手术可能与提高生存率有关，但并发症率高。病理残留疾病与高复发率和存活不良相关。
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.