之前的一项监测、流行病学和最终结果 (SEER) 研究显示，1988 年至 2009 年间，美国近距离放射治疗的使用率出现了令人担忧的下降。本研究评估了近距离放射治疗在宫颈癌中的应用的最新趋势，并确定了与使用近距离放射治疗相关的因素和生存获益。使用 SEER 数据，8500 名FIGO 2009 IB2-IVA 期宫颈癌患者接受了外照射放射治疗（EBRT）治疗。确定了2000-2020年。对与近距离放射治疗使用相关的潜在因素进行逻辑回归分析：年龄、婚姻状况、种族、民族、收入、大都市状况、诊断年份、SEER 区域、组织学、分级和分期。为了调整接受近距离放射治疗的患者与未接受近距离放射治疗的患者之间的差异，使用了倾向评分匹配。多变量 Cox 回归分析评估了匹配队列中近距离放射治疗与宫颈癌特异性死亡率 (CSM) 和全因死亡率 (ACM) 的关联。8500 名女性中，64% 接受了近距离放射治疗与 EBRT 联合治疗； 36% 仅接受 EBRT。近距离放射治疗使用率在2003/2004年急剧下降（2003年最低为44%），然后逐渐提高，特别是在2018-2020年（76%）。与近距离放射治疗使用几率较高相关的因素包括年龄较小、已婚（相对于单身）、诊断年龄较晚、某些 SEER 区域和早期阶段。在倾向评分匹配队列中，近距离放射治疗与较低的 4 年累积癌症死亡发生率（32.1% vs 43.4%，P<0.001）和更好的总生存率（OS，64.0% vs 51.4%，P<0.001）相关。 001）。近距离放射治疗与较低的 CSM（风险比 [HR] 0.70，95% CI 0.64-0.76；P<.001）和 ACM（HR 0.72，95% CI 0.67-0.78；P<.001）独立相关。自 2004 年以来，IB2-IVA 期宫颈癌患者的 SEER 区域有所改善。近距离放射治疗的使用仍然与显着降低 CSM 和 ACM 独立相关，并且是局部晚期宫颈癌患者治疗的重要组成部分。版权所有 © 2023。由 Elsevier Inc. 出版。

A previous Surveillance, Epidemiology, and End Results (SEER) study revealed a concerning decline in brachytherapy utilization in the United States between 1988-2009. This study evaluates recent trends in brachytherapy utilization in cervical cancer, and identifies factors and survival benefit associated with the use of brachytherapy treatment.Using SEER data, 8500 patients with FIGO 2009 stage IB2-IVA cervical cancer treated with external beam radiotherapy (EBRT) between 2000-2020 were identified. Logistic regression analysis was performed on potential factors associated with brachytherapy use: age, marital status, race, ethnicity, income, metropolitan status, year of diagnosis, SEER region, histology, grade and stage. To adjust for differences between patients who received brachytherapy and those who did not, propensity-score matching was used. Multivariable Cox regression analysis assessed the association of brachytherapy use with cervical cancer-specific mortality (CSM) and all-cause mortality (ACM) in the matched cohort.Sixty-four percent of the 8500 women received brachytherapy in combination with EBRT; 36% received EBRT alone. The brachytherapy utilization rate declined sharply in 2003/2004 (lowest rate 44% in 2003), and then gradually improved especially in 2018-2020 (76%). Factors associated with higher odds of brachytherapy use included younger age, married (versus single), later years of diagnosis, certain SEER regions and earlier stage. In the propensity-score matched cohort, brachytherapy treatment was associated with lower 4-year cumulative incidence of cancer death (32.1% vs 43.4%, P<.001) and better overall survival (OS, 64.0% vs 51.4%, P<.001). Brachytherapy treatment was independently associated with lower CSM (hazard ratio [HR] 0.70, 95% CI 0.64-0.76; P<.001) and ACM (HR 0.72, 95% CI 0.67-0.78; P<.001).Brachytherapy utilization among SEER regions has improved since 2004 in patients with stage IB2-IVA cervical cancer. Brachytherapy use remains independently associated with significantly lower CSM and ACM, and an essential component of treatment for patients with locally advanced cervical cancer.Copyright © 2023. Published by Elsevier Inc.