Schmid Seraina, Hsu I-Chow, Hu Jessica M, Sherman Alexander E, Osann Kathryn, Kapp Daniel S, Chan John K
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, 1600 Divisadero Street, Box 1702, San Francisco, CA 94143-1702, USA.
Gynecol Oncol. 2009 Nov;115(2):239-43. doi: 10.1016/j.ygyno.2009.07.005. Epub 2009 Aug 12.
To determine the association of adjuvant radiotherapy and outcomes of women with stage III node-positive uterine cancer.
All patients with surgically-staged stage III node-positive uterine cancer from the Surveillance Epidemiology and End Results database of the US National Cancer Institute from 1988 to 2001 were identified. Data were analyzed using Kaplan-Meier and logistic regression methods.
Of 943 women, the median age was 64 years (range: 28-93). 82.1%, 8.6%, and 6.8% were White, Black, and Asian respectively. The median number of removed nodes was 11. 54.9% had a single positive node and 45.1% had 2-5 positive nodes. Endometrioid, papillary serous, sarcomas, and clear cell carcinomas comprised of 69.7%, 16.3%, 9.9%, and 4.1% of histologies, respectively. 67.3% of the women underwent adjuvant radiotherapy with a 5-year disease-specific survival of 67.9% compared to 53.4% in those without radiotherapy (p<0.001). Adjuvant radiotherapy improved the survival from 54.4% to 74.3% (p<0.001) in those with a single positive node and from 52.4% to 59.7% (p=0.089) in those with 2-5 positive nodes. On multivariate analysis, older age, non-endometrioid histology, and lack of adjuvant radiotherapy remained as significant independent prognostic factors for worsened survival.
Our data suggest that adjuvant radiotherapy is associated with a significant survival benefit in women with single-positive node endometrioid uterine cancers. Prospective clinical trials are warranted to confirm these findings.
确定辅助放疗与III期淋巴结阳性子宫癌女性患者预后的相关性。
识别出美国国立癌症研究所监测、流行病学和最终结果数据库中1988年至2001年手术分期为III期淋巴结阳性子宫癌的所有患者。使用Kaplan-Meier法和逻辑回归方法进行数据分析。
943名女性患者的中位年龄为64岁（范围：28 - 93岁）。分别有82.1%、8.6%和6.8%为白人、黑人及亚洲人。切除淋巴结的中位数为11个。54.9%有单个阳性淋巴结，45.1%有2 - 5个阳性淋巴结。子宫内膜样癌、乳头状浆液性癌、肉瘤和透明细胞癌分别占组织学类型中的比例为69.7%、16.3%、9.9%和4.1%。67.3%的女性接受了辅助放疗，其5年疾病特异性生存率为67.9%，而未接受放疗的患者为53.4%（p<0.001）。辅助放疗使单个阳性淋巴结患者的生存率从54.4%提高到74.3%（p<0.001），使2 - 5个阳性淋巴结患者的生存率从52.4%提高到59.7%（p = 0.089）。多因素分析显示，年龄较大、非子宫内膜样组织学类型以及缺乏辅助放疗仍然是生存恶化的显著独立预后因素。
我们的数据表明，辅助放疗与单个阳性淋巴结子宫内膜样子宫癌女性患者的显著生存获益相关。有必要进行前瞻性临床试验以证实这些发现。
