Department of Radiation Oncology, University of California, Davis, Health System, Sacramento, CA, USA.
Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3):728-34. doi: 10.1016/j.ijrobp.2009.02.077. Epub 2009 Aug 21.
To determine clinical and pathological factors significant for overall survival (OS) and local-regional failure-free survival (LRFFS) in uterine sarcoma as they relate to adjuvant radiotherapy (AR).
A retrospective analysis of 3,650 patients with uterine sarcoma was conducted using the National Oncology Database, a proprietary database of aggregated tumor registries owned by Impac Medical Systems (Sunnyvale, CA). Adjuvant radiotherapy was defined as postoperative external beam radiation to the pelvis, with or without brachytherapy. Prognostic factors were identified by multivariate analysis (MVA) using the Cox proportional hazards model. The Kaplan-Meier method was used to estimate survival, with significant differences (p < 0.05) determined using the log-rank test.
The median follow-up time was 59 months, with a 5-year OS of 37%. Significant prognostic factors for OS were stage, race/ethnicity, grade, age, histology, lymph node status, and surgical treatment (p < 0.01 for all factors). Use of AR was not predictive for OS. For nonmetastatic cancer patients receiving definitive surgery (n = 2,206), the 5-year LRFFS was 87%. In this group, stage, grade, histology, and AR were prognostic for LRFFS (p < 0.05), with AR associated with improved outcome compared with surgery alone (hazard ratio = 0.4, p < 0.001). Patients with carcinosarcoma, endometrial stromal sarcoma, leiomyosarcoma, poorly differentiated tumors, and negative lymph nodes had reduced local-regional failure (LRF) with AR (log-rank, p < 0.05 for all).
In the largest retrospective analysis of uterine sarcoma published thus far, AR conferred a 53% reduction in the risk of LRF at 5 years. Use of AR may have broader indications than what are currently accepted in clinical practice.
确定与辅助放疗（AR）相关的影响子宫肉瘤总生存（OS）和局部区域无失败生存（LRFFS）的临床和病理因素。
利用 Impac Medical Systems（加利福尼亚州森尼韦尔）拥有的聚合肿瘤登记处的专有数据库——国家肿瘤数据库，对 3650 名子宫肉瘤患者进行了回顾性分析。辅助放疗被定义为盆腔外照射术后放疗，包括或不包括近距离放疗。使用 Cox 比例风险模型的多变量分析（MVA）确定预后因素。Kaplan-Meier 方法用于估计生存，使用对数秩检验确定显著差异（p<0.05）。
中位随访时间为 59 个月，5 年 OS 为 37%。OS 的显著预后因素包括分期、种族/民族、分级、年龄、组织学、淋巴结状态和手术治疗（所有因素的 p<0.01）。AR 的使用不能预测 OS。对于接受确定性手术的非转移性癌症患者（n=2206），5 年 LRFFS 为 87%。在该组中，分期、分级、组织学和 AR 与 LRFFS 相关（p<0.05），与单独手术相比，AR 可改善预后（风险比=0.4，p<0.001）。AR 可降低具有癌肉瘤、子宫内膜间质肉瘤、平滑肌肉瘤、低分化肿瘤和阴性淋巴结的患者的局部区域失败风险（对数秩，所有因素的 p<0.05）。
在迄今为止发表的最大的子宫肉瘤回顾性分析中，AR 可使 5 年内 LRF 的风险降低 53%。AR 的使用可能比目前临床实践中接受的更广泛。
