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Войти в исследования Translational cancer research · 2026
The risk factors and patterns for distant metastasis in early-stage cervical adenocarcinoma patients receiving radical surgery and adjuvant radiotherapy: the ATTRACT study.
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Zhu Jia-Wei, Yang Xi-Lin, Zhou Yun-Can, You Yan, Peng Peng, Zhen Hong-Nan, Wang Xi, Lian Xin, Yan Jun-Fang, Zhang Fu-Quan
Аннотация
BACKGROUND: Cervical adenocarcinoma (ADC) accounts for 15-25% of cervical cancer cases and carries a higher risk of distant metastasis (DM) and a poorer prognosis than squamous cell carcinoma (SCC). However, the DM patterns and risk factors in ADC patients receiving radical surgery and postoperative radiotherapy (PORT) remain insufficiently characterized. This study aimed to explore the DM pattern and risk factors associated with DM in ADC patients receiving radical surgery and postoperative radiotherapy.
METHODS: Patients with pathologically confirmed ADC after radical surgery were selected. The DM pattern was described using a metastatic organ distribution map. Survival outcomes were estimated using the Kaplan-Meier method, and intergroup differences were compared using the log-rank test. Risk factors for DM were identified through Cox regression analysis. A restricted cubic spline (RCS) curve was used to evaluate the association between the odds ratio (OR) for DM and cumulative platinum dose throughout treatment.
RESULTS: The most prevalent DM organ was the lung (51.1%), followed by liver (26.7%) and bone (24.4%). No significant difference regarding 5-year overall survival (OS) was observed between patients with single-site DM and those with multiple-site DM (44.2% vs. 44.9%; P>0.99). Similarly, patients without synchronous loco-regional failure (LRR) did not outperform those with synchronous LRR (49.6% vs. 44.4%; P=0.21). Lymph node metastasis (LNM) and depth of myometrial invasion (DOI) ≥1/2 were independent risk factors for DM. Three risk subgroups with distinct 5-year distant metastasis-free survival (DMFS) were constructed, including high-risk (LNM+ and DOI ≥1/2), middle-risk (LNM+ and DOI <1/2; LNM- and DOI ≥1/2), and low-risk subgroup (LNM- and DOI <1/2). Furthermore, cumulative platinum doses of 50 to 150 mg/m2 were associated with a lower OR for DM, though this association did not reach statistical significance (P=0.02).
CONCLUSIONS: The most common DM site for ADC patients after surgery and adjuvant radiotherapy was the lung. The risk factors for DM in those patients were LNM and DOI ≥1/2. Additionally, the prevention of DM could not be simply achieved by increasing the platinum dose during the primary treatment period.
METHODS: Patients with pathologically confirmed ADC after radical surgery were selected. The DM pattern was described using a metastatic organ distribution map. Survival outcomes were estimated using the Kaplan-Meier method, and intergroup differences were compared using the log-rank test. Risk factors for DM were identified through Cox regression analysis. A restricted cubic spline (RCS) curve was used to evaluate the association between the odds ratio (OR) for DM and cumulative platinum dose throughout treatment.
RESULTS: The most prevalent DM organ was the lung (51.1%), followed by liver (26.7%) and bone (24.4%). No significant difference regarding 5-year overall survival (OS) was observed between patients with single-site DM and those with multiple-site DM (44.2% vs. 44.9%; P>0.99). Similarly, patients without synchronous loco-regional failure (LRR) did not outperform those with synchronous LRR (49.6% vs. 44.4%; P=0.21). Lymph node metastasis (LNM) and depth of myometrial invasion (DOI) ≥1/2 were independent risk factors for DM. Three risk subgroups with distinct 5-year distant metastasis-free survival (DMFS) were constructed, including high-risk (LNM+ and DOI ≥1/2), middle-risk (LNM+ and DOI <1/2; LNM- and DOI ≥1/2), and low-risk subgroup (LNM- and DOI <1/2). Furthermore, cumulative platinum doses of 50 to 150 mg/m2 were associated with a lower OR for DM, though this association did not reach statistical significance (P=0.02).
CONCLUSIONS: The most common DM site for ADC patients after surgery and adjuvant radiotherapy was the lung. The risk factors for DM in those patients were LNM and DOI ≥1/2. Additionally, the prevention of DM could not be simply achieved by increasing the platinum dose during the primary treatment period.