Revisiting Milan cervical cancer study: Do the original findings hold in the era of chemotherapy?
| Autor: | William Small, Lara Hathout, W. Ross Green, Mohamed A. Elshaikh, Atif J. Khan, Omar Mahmoud, Sushil Beriwal |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Oncology medicine.medical_specialty Multivariate analysis medicine.medical_treatment Uterine Cervical Neoplasms 01 natural sciences law.invention 010104 statistics & probability 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans 0101 mathematics Stage (cooking) Propensity Score Prospective cohort study Aged Neoplasm Staging Cervical cancer business.industry Obstetrics and Gynecology Chemoradiotherapy Middle Aged medicine.disease Surgery Radiation therapy 030220 oncology & carcinogenesis Propensity score matching Cohort Female business |
| Zdroj: | Gynecologic Oncology. 144:299-304 |
| ISSN: | 0090-8258 |
| Popis: | Background The primary treatment of early stage cervical carcinoma (IB-IIA) is either surgery or radiation therapy based on the pivotal Milan randomized study published twenty years ago. In the presence of high-risk features, the gold standard treatment is concurrent chemotherapy and radiation therapy (CRT) whether it is the in the postoperative or the definitive setting. Using the National Cancer Data Base (NCDB), the goal of our study is to compare the outcomes of surgery and radiation therapy in the chemotherapy era. Methods Between 2004 and 2013, 5478 patients diagnosed with early stage cervical cancer were divided into 2 groups based on their primary treatment: non-surgical ( n =1980) and surgical groups ( n =3498). The distribution of patient/tumor characteristics and treatment variables with their relation to overall survival and proportional regression models were assessed to investigate the superiority of one approach over the other. Propensity score analysis adjusted for imbalance of covariates to create a well-matched-patient cohort. Findings At 46months median follow-up, the 5-year overall survival was similar between both groups (73·8% vs. 75.7%; p =0.619) after applying propensity score analysis. On multivariate analysis, high Charlson comorbidity score, stage IIA disease, larger tumor size, positive lymph nodes and high-grade disease were significant predictors of poor outcome while older age and treatment approach were not. Interpretation Our analysis suggests that surgery (followed by adjuvant RT or CRT) and definitive radiotherapy (with or without chemotherapy) result in equivalent survival. Prospective studies are warranted to establish this paradigm in the chemotherapy era. |
| Databáze: | OpenAIRE |
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