编者按：妇女能顶半边天，而保障中国女性健康，撑起妇科肿瘤防治的保护伞，需要整合更多妇科肿瘤防治事业的资源和力量。在“2023中国整合肿瘤学大会（2023 CCHIO）”开幕前夕，《肿瘤瞭望》采访了中国抗癌协会宫颈癌专业委员会主任委员、中山大学孙逸仙纪念医院林仲秋教授，介绍我国妇科肿瘤的防治现状、晚期维持治疗的研究进展以及中国抗癌协会宫颈癌专业委员会的发展愿景。

 

Editor’s Note:Protecting the health of Chinese women and providing a robust defense against gynecological cancer requires the integration of more resources and efforts in the field of gynecological cancer prevention and treatment.On the eve of the"2023 Chinese Congress on Holistic Integrative Oncology(2023 CCHIO)，""Oncology Frontier"interviewed Professor Zhongqiu Lin，Chairman of the Cervical Cancer Professional Committee of the China Anti-Cancer Association and Sun Yat-sen Memorial Hospital，to discuss the current status of gynecological cancer prevention and treatment in China，recent advances in maintenance therapy for advanced-stage cases，and the developmental vision of the Cervical Cancer Professional Committee of the China Anti-Cancer Association.

 

林仲秋教授：在三大妇科肿瘤中，发病率最高的是宫颈癌，其次是子宫内膜癌和卵巢癌。总体上，我国妇科肿瘤的防治任务仍然较重。以宫颈癌为例，2020年中国新增109 741例宫颈癌患者，标化发病率为10.7/10万；新增59 000多例宫颈癌死亡患者，标化死亡率为5.3/10万。宫颈癌发病和死亡率高主要与以下几方面因素有关：第一是我们在预防方面有待提高，HPV疫苗的接种率相较发达国家更低；第二是早期筛查水平的地区不平衡，在一些偏远和落后地区，妇科两癌筛查做得不够充分，不能定期为目标人群提供筛查从而切断宫颈癌变和进展的途径；第三是宫颈癌的治疗水平存在地区差异，偏远和落后地区缺乏足够的放疗设备和手术技术条件，这是制约我们提升宫颈癌患者生存率的严峻问题之一。

 

在三大妇科肿瘤中，子宫内膜癌的早诊率相对好一些，因为大部分患者可以通过异常阴道出血等症状发现疾病，早期治疗效果相对更好。卵巢癌发病则相对隐匿，也是我们妇科肿瘤防治的一个弱项。2020年我国新增卵巢癌55 000多例，死亡37 000多例，是全球卵巢癌新发病例数最多、死亡率排名靠前的国家。因此，我国妇科肿瘤的防治还需要社会各界共同努力，更好地进行预防、筛查和诊治，使广大女性的健康得到更好的保障。

 

Professor Zhongqiu Lin:Among the three major gynecological cancers，cervical cancer has the highest incidence，followed by endometrial cancer and ovarian cancer.Overall，the task of preventing and treating gynecological cancers in China remains substantial.Taking cervical cancer as an example，in 2020，there were 109，741 new cases of cervical cancer in China，with a standardized incidence rate of 10.7 per 100，000 people.There were over 59，000 new cases of cervical cancer-related deaths，with a standardized mortality rate of 5.3 per 100，000 people.The high incidence and mortality of cervical cancer are mainly related to several factors.First，more efforts are required for prevention improvement，as we have lower HPV vaccination rates compared to developed countries.Second，early screening outcomes vary across different regions.In some remote and underdeveloped areas，gynecological cancer screenings are inadequate，which hinders regular screening for the target population to interrupt the progression of cervical cancer.Third，there are regional disparities in the treatment of cervical cancer，with insufficient radiotherapy equipment and surgical expertise in remote and underdeveloped areas，posing a serious challenge to improving the survival rates of cervical cancer patients.

 

Among the three major gynecological cancers，endometrial cancer has a relatively higher early diagnosis rate because it features evident early symptoms such as abnormal vaginal bleeding，thus leading to better treatment outcomes.Ovarian cancer，on the other hand，is more insidious and represents a weak point in our gynecological cancer prevention and treatment.In 2020，there were over 55，000 new cases of ovarian cancer in China，resulting in over 37，000 deaths.China has the highest number of new cases of ovarian cancer and ranks high in terms of ovarian cancer mortality worldwide.Therefore，the prevention and treatment of gynecological cancers in China requires collaborative efforts from various sectors to improve prevention，screening，diagnosis，and treatment and provide better health protection for women.

 

林仲秋教授：整合医学在肿瘤防治中的应用，可以概况为“防、筛、诊、治、康”五个字，即肿瘤的预防、筛查、诊断、治疗和康复。我们需要将患者视为一个整体，除了诊断和治疗疾病以外，我们还需要帮助患者进行生理和心理的康复，使其能够回归正常或接近正常人的生活状态，继续完成其家庭、社会和工作角色。这个过程除了需要临床医生以外，还需要护理、康复、心理专家，以及公益、社区组织等多方面的力量参与。

 

预防是癌症防治的重点，宫颈癌的预防是当前实体瘤预防的典范。临床中大约有90%以上的宫颈癌与高危型HPV感染相关，HPV疫苗可有效预防宫颈癌，提供了较为确切的病因预防手段。实际上，HPV从感染到进展为癌前病变、宫颈癌的过程很长，我们有充足的时间来进行筛查。宫颈癌的预防和筛查，需要从国家层面进行免疫规划，以及对适龄妇女进行免费筛查，这同样需要整合更多方面的力量和资源。

 

由此可见，整合医学在妇科肿瘤防治中是实用且有效的，特别是在宫颈癌防治中，更能体现“防筛诊治康”的完整过程。希望通过这些新理念的引入，能够减少妇科肿瘤的发生，让更多妇科肿瘤患者得到更加完整的治疗和康复，更好地回归社会和融入生活。

 

Professor Zhongqiu Lin:The application of holistic medicine in cancer prevention and treatment can be summarized as"prevention，screening，diagnosis，treatment，and recovery".We should approach patients holistically，not only diagnosing and treating the disease but also assisting in their physiological and psychological recovery，enabling them to return to a normal or near-normal state of life and continue fulfilling their roles in their families，society，and work.This process involves not only clinical doctors but also nursing，rehabilitation，and psychological experts，as well as the involvement of public welfare and community organizations.

 

Prevention is a key focus of cancer prevention.Cervical cancer prevention serves as a paradigm for solid tumor prevention.In clinical practice，over 90%of cervical cancer cases are associated with high-risk HPV infections.HPV vaccines effectively prevent cervical cancer and provide a well-established method for etiological prevention.In fact，the progression from HPV infection to the development of cervical cancer occurs over an extended period，providing a substantial window for screening.Cervical cancer prevention and screening need to be implemented at the national level，including immunization planning and free screenings for eligible women，which also require the integration of more resources and efforts.

 

Therefore，integrative medicine is practical and effective in the prevention and treatment of gynecological cancers，especially in the prevention of cervical cancer，where it can fully encompass the entire process of"prevention，screening，diagnosis，treatment，and recovery."It is hoped that the introduction of these new concepts can reduce the incidence of gynecological cancers，providing more comprehensive treatment and recovery for gynecological cancer patients，and enabling them to return to society and integrate into life more effectively.

 

林仲秋教授：PARPi是利用“合成致死”杀灭肿瘤细胞的新型靶向治疗药物，可以阻止肿瘤细胞的自我修复，目前已经成为卵巢癌一线维持治疗标准，主要用于存在BRCA突变和同源重组修复缺陷（HRD）的患者中。我们知道大多数卵巢癌初诊已是中晚期，经过手术、化疗后，仍有大约75%的患者在3年时发生复发。我们的治疗策略是推迟肿瘤复发和进展，但手术、化疗的次数是有限的，不宜作为长期的维持治疗策略。PARPi口服方便，疗效和安全性得到临床验证，是理想的卵巢癌维持治疗药物。SOLO-1研究显示，初治卵巢癌BRCA突变患者完成手术和化疗后接受PARPi奥拉帕利维持治疗，可相较于安慰剂组的PFS显著延长42.2个月（56.0 vs 13.8个月，HR 0.33，95%CI：0.25~0.43），也就是说奥拉帕利能够使患者的复发进展推迟3年半以上；尤其令人欣喜的是在该研究的7年随访中，奥拉帕利组患者的7年OS率高达67%，死亡风险显著降低45%（NR vs 75.2个月，HR 0.55，95%CI：0.40~0.76；P=0.0004），意味着有将近7成的患者能够长期生存超过7年。

 

宫颈癌患者中的BRCA突变发生率较低，所以PARPi并不常规应用，但维持治疗的模式在宫颈癌中也有体现。晚期宫颈癌患者在完成化疗联合抗血管生成药物贝伐珠单抗后，可继续使用贝伐珠单抗维持治疗，但其推迟复发进展的效果不像卵巢癌PARPi维持治疗那样明显，仅能推迟复发进展几个月，近年来维持治疗则加入了PD-1/L1免疫检查点抑制剂，取得了不错的疗效；此外还有一些小分子TKI也用于宫颈癌维持治疗，总体上都没有卵巢癌PARPi维持治疗的效果那么突出。

 

子宫内膜癌与宫颈癌也是类似的，主要通过免疫或抗血管生成药物来进行维持治疗，也有初步的研究探索使用PARPi维持治疗，比如2023年ESMO大会报道的Ⅱb期UTOLA试验（摘要号：LBA42）显示奥拉帕利维持治疗可以延长HRD阳性晚期子宫内膜癌患者的PFS（5.4 vs 3.6个月，HR 0.59，P=0.02），值得进一步扩大研究验证。

 

Professor Zhongqiu Lin:PARPi is a new type of targeted therapy that kills tumor cells by using the"synthetic lethality"concept，which can prevent tumor cells from repairing themselves.It has now become the standard for first-line maintenance therapy in ovarian cancer，mainly used in patients with BRCA mutations and homologous recombination repair defects(HRD).We know that the majority of ovarian cancer cases are diagnosed at an advanced stage.Even after surgery and chemotherapy，approximately 75%of patients experience recurrence within three years.Our treatment strategy aims to delay tumor recurrence and progression，but surgery and chemotherapy are limited and not suitable for long-term maintenance therapy.PARPi，administered orally，is convenient，and its efficacy and safety have been clinically validated，making it an ideal drug for maintaining ovarian cancer.The SOLO-1 study showed that in newly diagnosed ovarian cancer patients with BRCA mutations who received maintenance therapy with the PARPi olaparib after surgery and chemotherapy，the progression-free survival(PFS)was significantly extended by 42.2 months(56.0 vs.13.8 months，HR 0.33，95%CI:0.25~0.43).In other words，olaparib can delay the recurrence and progression of disease by more than three and a half years.Particularly encouraging is the 7-year follow-up in the study，where patients in the olaparib group had a 7-year overall survival rate of up to 67%，with a significant 45%reduction in the risk of death(NR vs.75.2 months，HR 0.55，95%CI:0.40~0.76;P=0.0004).This means that nearly 70%of patients can achieve long-term survival of over seven years.

 

The occurrence of BRCA mutations in cervical cancer patients is relatively low，so PARPi is not routinely used.However，the maintenance therapy model is also applicable to cervical cancer.In late-stage cervical cancer patients who have completed chemotherapy with the anti-angiogenic drug bevacizumab，bevacizumab can be continued as maintenance therapy.However，it only delays disease recurrence and progression by a few months，which is not as pronounced as that of PARPi in ovarian cancer maintenance therapy.In recent years，the addition of PD-1/L1 immune checkpoint inhibitors to maintenance therapy has achieved good results.Additionally，some small molecule TKIs are also used for maintenance therapy in cervical cancer，but overall，none of these options have shown the outstanding effects of PARPi in ovarian cancer maintenance therapy.

 

Endometrial cancer is similar to cervical cancer，primarily utilizing immunotherapy or anti-angiogenic drugs for maintenance therapy.There are also preliminary studies exploring the use of PARPi for maintenance therapy.For example，the UTOLA trial in stage IIb endometrial cancer patients reported at the 2023 ESMO Congress(Abstract LBA42)showed that olaparib maintenance therapy could extend the PFS of HRD-positive advanced-stage endometrial cancer patients(5.4 vs.3.6 months，HR 0.59，P=0.02)，warranting further research and validation.

 

林仲秋教授：中国抗癌协会妇科肿瘤专业委员会经过了六届委员会的发展，为我国妇科肿瘤学科的发展奠定了良好的基础。随着各个妇科肿瘤的诊疗研究快速发展，今年5月我们将原妇科肿瘤专委会划分为宫颈癌、卵巢癌、子宫内膜癌三个新的专委会。在宫颈癌专委会的职责中，还包括外阴癌、阴道癌的防治工作。我很荣幸成为首届宫颈癌专委会的主任委员，深感责任重大。

 

新成立宫颈癌专委会，使我们有更多的力量、更专注地开展宫颈癌的防治工作，我们会组织专家深入总结循证医学证据，编写更加详细的宫颈癌诊疗指南，从宫颈癌的筛查、诊断、分期，到不同的手术治疗、放疗和全身治疗，我们将进行更加细致的总结和推荐。除了常见的宫颈鳞癌以外，还将讨论宫颈腺癌、神经内分泌癌、透明细胞癌等少见病理类型的诊断和治疗。另一方面，我们要开展广泛而深入的学术交流，把最前沿的研究进展和最新的诊疗理念，通过宫颈癌专委会这个平台，与国内外同道进行交流分享，包括举办学术沙龙、指南巡讲等丰富多彩的学习活动，以提高我国宫颈癌的规范化诊疗水平。

 

目前，宫颈癌专委会已经在全国吸纳发展了2830名会员，我们将继续壮大人才队伍，重视中青年医生的培养，开展中青年医生的培训项目，以提高他们的临床、科研、教学水平。我们还将开展更加广泛的科普工作，结合网络优势，尝试在短视频平台上进行宫颈癌的科普教育工作。此外，我们将发挥专委会的平台优势，推动开展更多全国多中心的临床研究，从而提高我国宫颈癌的研究水平。

 

希望通过大家的努力，能够引领中国宫颈癌防治事业再上新台阶，能够将整合医学的理念更好地贯彻到宫颈癌防治工作中，能够进一步提高我国宫颈癌的整体诊治水平，最重要的是能够使更多中国女性能够从中获益，为她们的健康保驾护航，助力“健康中国”伟大蓝图的实现。

 

Professor Zhongqiu Lin:The Cervical Cancer Professional Committee of the China Anti-Cancer Association has developed over six terms and laid a strong foundation for the development of gynecological oncology in China.With the rapid advancement of research in the diagnosis and treatment of various gynecological cancers，in May of this year，we divided the original Gynecological Oncology Professional Committee into three new committees:Cervical Cancer，Ovarian Cancer，and Endometrial Cancer.The responsibilities of the Cervical Cancer Professional Committee also include the prevention and treatment of vulvar and vaginal cancers.I am honored to be the inaugural chairman of the Cervical Cancer Professional Committee and feel a great sense of responsibility.

 

The establishment of the Cervical Cancer Professional Committee allows us to focus more on the prevention and treatment of cervical cancer with greater resources and expertise.We will organize experts to comprehensively review evidence-based medicine，and write more detailed guidelines for the diagnosis and treatment of cervical cancer，covering screening，diagnosis，staging，and various surgical，radiation，and systemic treatments，providing more detailed recommendations.In addition to the common squamous cell carcinoma of the cervix，we will also discuss the diagnosis and treatment of rare pathological types such as cervical adenocarcinoma，neuroendocrine carcinoma，and clear cell carcinoma.On the other hand，we will conduct extensive and in-depth academic exchanges，sharing the latest research advances and treatment concepts with colleagues at home and abroad through the platform of the Cervical Cancer Professional Committee，including academic salons，guideline lectures，and a variety of learning activities to enhance the standardized diagnosis and treatment of cervical cancer in China.

 

Currently，the Cervical Cancer Professional Committee has recruited 2，830 members nationwide，and we will continue to expand the talent pool，focusing on the training of young and middle-aged doctors by conducting training programs to improve their clinical，research，and teaching skills.We will also carry out extensive public education work，utilizing the advantages of online platforms to conduct public education on cervical cancer through short video platforms.Furthermore，we will leverage the platform advantage of the committee to encourage more multicenter clinical research nationwide，thus elevating the research standards in the field of cervical cancer in China.

 

It is hoped that through our collective efforts，we can lead the cause of cervical cancer prevention and treatment in China to new heights，better integrate the concept of integrated medicine into cervical cancer prevention and treatment，further improve the overall diagnosis and treatment level of cervical cancer in China，and most importantly，benefit more Chinese women，assisting them in safeguarding their health and contributing to the realization of the great vision of"Healthy China."