Macdonald O Kenneth, Sause William T, Lee R Jeffrey, Lee Christopher M, Dodson Mark K, Zempolich Karen, Gaffney David K
Department of Radiation Oncology, Huntsman Cancer Hospital at the University of Utah, Salt Lake City, UT 84112-5560, USA.
Gynecol Oncol. 2006 Nov;103(2):661-6. doi: 10.1016/j.ygyno.2006.05.002. Epub 2006 Jun 23.
The role of post-operative radiotherapy (RT) in women with early-stage, low to intermediate risk cancer of the uterine corpus remains controversial. The primary objective of this analysis was to evaluate the survival outcomes of women with early-stage endometrial cancer treated with surgery alone or surgery followed by RT.
Data from two institutions were collected from 1990 to 2003. The 608 eligible women had FIGO stage IA to IIA endometrial cancer and underwent primary surgery +/-RT. Univariate and multivariate analyses of pertinent variables were performed for the end points of disease-free survival (DFS) and overall survival (OS).
The median age for all women was 64 years. RT was delivered to 133 women (22%). Unfavorable histologic grade (P < 0.0001) and stage (P < 0.0001) were significantly more prevalent in the adjuvant RT group. At a median follow-up of 5.2 years, 26 pelvic (11 vaginal) and 16 distant failures occurred along with 110 deaths (with no significant differences between women undergoing surgery alone or followed by RT). Adjuvant RT, younger age, and lower stage predicted for improved DFS and OS on multivariate analysis. Stratified analysis revealed that adjuvant RT conferred a survival benefit in women with stage IC or IIA disease.
Adjuvant RT was associated with improved disease-free and overall survival in women with higher risk disease. Despite significantly worse disease characteristics among women in the adjuvant RT group, the analyzed end points were equivalent among the two groups. These findings suggest that adjuvant radiotherapy has a significant benefit in reducing mortality and disease progression in early-stage carcinoma of the uterine corpus.
术后放疗（RT）在早期、低至中度风险的子宫体癌女性患者中的作用仍存在争议。本分析的主要目的是评估单纯手术或手术联合RT治疗的早期子宫内膜癌女性患者的生存结局。
收集了1990年至2003年两个机构的数据。608名符合条件的女性患有FIGO IA期至IIA期子宫内膜癌，并接受了初次手术±RT。对无病生存期（DFS）和总生存期（OS）的终点进行了相关变量的单因素和多因素分析。
所有女性的中位年龄为64岁。133名女性（22%）接受了RT。辅助RT组中，不良组织学分级（P < 0.0001）和分期（P < 0.0001）更为常见。中位随访5.2年时，发生了26例盆腔（11例阴道）和16例远处复发，以及110例死亡（单纯手术或术后放疗的女性之间无显著差异）。多因素分析显示，辅助RT、年龄较小和分期较低可预测DFS和OS改善。分层分析显示，辅助RT对IC期或IIA期疾病的女性有生存获益。
辅助RT与高风险疾病女性的无病生存期和总生存期改善相关。尽管辅助RT组女性的疾病特征明显更差，但两组的分析终点相当。这些发现表明，辅助放疗在降低子宫体早期癌的死亡率和疾病进展方面具有显著益处。
