辅助近距离放射治疗消除了IIIC期子宫内膜癌局部疾病扩展的生存劣势：一项监测、流行病学和最终结果（SEER）数据库分析

Adjuvant brachytherapy removes survival disadvantage of local disease extension in stage IIIC endometrial cancer: a SEER registry analysis.

作者信息

Rossi Peter J, Jani Ashesh B, Horowitz Ira R, Johnstone Peter A S

机构信息

Department of Radiation Oncology, Emory University School of Medicine, 1365 Clifton Rd., NE, Atlanta, GA 30322, USA.

出版信息

Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):134-8. doi: 10.1016/j.ijrobp.2007.05.048. Epub 2007 Sep 12.

DOI:10.1016/j.ijrobp.2007.05.048

PMID:17855014

Abstract

PURPOSE

To assess the role of radiotherapy (RT) in women with Stage IIIC endometrial cancer.

METHODS AND MATERIALS

The 17-registry Survival, Epidemiology, and End Results (SEER) database was searched for patients with lymph node-positive non-Stage IV epithelial endometrial cancer diagnosed and treated between 1988 and 1998. Two subgroups were identified: those with organ-confined Stage IIIC endometrial cancer and those with Stage IIIC endometrial cancer with direct extension of the primary tumor. RT was coded as external beam RT (EBRT) or brachytherapy (BT). Observed survival (OS) was reported with a minimum of 5 years of follow-up; the survival curves were compared using the log-rank test.

RESULTS

The therapy data revealed 611 women with Stage IIIC endometrial cancer during this period. Of these women, 51% were treated with adjuvant EBRT, 21% with EBRT and BT, and 28% with no additional RT (NAT). Of the 611 patients, 293 had organ-confined Stage IIIC endometrial cancer and 318 patients had Stage IIIC endometrial cancer with direct extension of the primary tumor. The 5-year OS rate for all patients was 40% with NAT, 56% after EBRT, and 64% after EBRT/BT. Adjuvant RT improved survival compared with NAT (p <0.001). In patients with organ-confined Stage IIIC endometrial cancer, the 5-year OS rate was 50% for NAT, 64% for EBRT, and 67% for EBRT/BT. Again, adjuvant RT contributed to improved survival compared with NAT (p = 0.02). In patients with Stage IIIC endometrial cancer and direct tumor extension, the 5-year OS rate was 34% for NAT, 47% for EBRT, and 63% for EBRT/BT. RT improved OS compared with NAT (p <0.001). Also, in this high-risk subgroup, adding BT to EBRT was superior to EBRT alone (p = 0.002).

CONCLUSION

Women with Stage IIIC endometrial cancer receiving adjuvant EBRT and EBRT/BT had improved OS compared with patients receiving NAT. When direct extension of the primary tumor was present, the addition of BT to EBRT was even more beneficial.

摘要

目的

评估放疗（RT）在IIIC期子宫内膜癌女性患者中的作用。

方法和材料

检索17个登记处的生存、流行病学和最终结果（SEER）数据库，查找1988年至1998年期间诊断并接受治疗的淋巴结阳性非IV期上皮性子宫内膜癌患者。确定了两个亚组：器官局限型IIIC期子宫内膜癌患者和原发性肿瘤直接蔓延的IIIC期子宫内膜癌患者。放疗编码为外照射放疗（EBRT）或近距离放疗（BT）。报告观察到的生存期（OS），随访时间至少5年；使用对数秩检验比较生存曲线。

结果

治疗数据显示，在此期间有611名IIIC期子宫内膜癌女性患者。在这些女性患者中，51%接受辅助EBRT治疗，21%接受EBRT和BT治疗，28%未接受额外放疗（NAT）。在611例患者中，293例为器官局限型IIIC期子宫内膜癌，318例为原发性肿瘤直接蔓延的IIIC期子宫内膜癌。所有患者的5年OS率，NAT组为40%，EBRT组为56%，EBRT/BT组为64%。与NAT相比，辅助放疗提高了生存率（p<0.001）。在器官局限型IIIC期子宫内膜癌患者中，NAT组的5年OS率为50%，EBRT组为64%，EBRT/BT组为67%。同样，与NAT相比，辅助放疗有助于提高生存率（p = 0.02）。在原发性肿瘤直接蔓延的IIIC期子宫内膜癌患者中，NAT组的5年OS率为34%，EBRT组为47%，EBRT/BT组为63%。与NAT相比，放疗改善了OS（p<0.001）。此外，在这个高危亚组中，EBRT联合BT优于单纯EBRT（p = 0.002）。