FIGO 分期 III 期子宫内膜癌患者辅助治疗的应用：一项多中心回顾性研究。

Use of adjuvant therapy in patients with FIGO stage III endometrial carcinoma: a multicenter retrospective study.

机构信息

Dipartimento di Scienze Ginecologico-Ostetriche e Scienze Urologiche, Università di Roma Sapienza, Roma, Italy.

出版信息

Oncology. 2011;81(2):104-12. doi: 10.1159/000331677. Epub 2011 Oct 4.

DOI:10.1159/000331677

PMID:21986449

Abstract

OBJECTIVES

Adjuvant treatment for stage III endometrial cancer is not yet defined. Previous experiences support the usefulness of combined chemotherapy and radiotherapy. The aim of this retrospective study was to describe the outcome in a cohort of patients with stage III endometrial cancer treated with chemotherapy and/or radiotherapy.

METHODS

A multicenter retrospective analysis of patients with stage III endometrial cancer from 1998 to 2009 was conducted. The impact on relapse-free survival of clinical and pathological variables and adjuvant treatment received was analyzed by univariate and multivariate analysis.

RESULTS

Eighty-two patients were considered. Median age was 62 years (range 38-82). Seventy-eight (95%) patients received an adjuvant treatment: chemotherapy (41; 50%), radiotherapy (18; 22%), or combined chemo-radiotherapy (19; 23%). Four patients were excluded from analysis because they were not treated with any adjuvant therapy. At univariate analysis, tumor grade (G3 vs. G1-G2; p = 0.003) was associated with risk of recurrence; similarly, patients treated with radiotherapy alone (p = 0.031, hazard ratio 0.19, 95% CI 0.04-0.86) or chemotherapy alone (p = 0.053, hazard ratio 0.54, 95% CI 0.29-1.01) had a significantly higher risk for relapse, compared to those treated with the multimodality approach. Relapse-free survival at 3 years was 86.5, 65.8 and 44.1%, with the multimodality approach, chemotherapy and radiotherapy, respectively. At multivariable analysis, age and grading were independently associated with recurrence-free survival. Hazard ratio for relapse-free survival was 0.14 (95% CI 0.02-1.04) and 0.20 (95% CI 0.04-1.11) for multimodality treatment compared to chemotherapy alone and radiotherapy alone, respectively.

CONCLUSIONS

Age and grading are independent prognostic factors. A combined approach with radiotherapy and chemotherapy may induce an advantage in relapse-free survival compared to radiotherapy or chemotherapy alone. Prospective clinical trials are needed to verify this clinical hypothesis.

摘要

目的

对于 III 期子宫内膜癌的辅助治疗尚未明确。既往经验支持联合化疗和放疗的有效性。本回顾性研究的目的是描述 1998 年至 2009 年期间接受化疗和/或放疗的 III 期子宫内膜癌患者的结果。

方法

对 1998 年至 2009 年期间的 III 期子宫内膜癌患者进行了多中心回顾性分析。通过单因素和多因素分析，分析临床和病理变量以及接受的辅助治疗对无复发生存的影响。

结果

共纳入 82 例患者。中位年龄为 62 岁（范围 38-82 岁）。78（95%）例患者接受了辅助治疗：化疗（41 例；50%）、放疗（18 例；22%）或联合化疗-放疗（19 例；23%）。因未接受任何辅助治疗而将 4 例患者排除在分析之外。单因素分析显示，肿瘤分级（G3 与 G1-G2；p=0.003）与复发风险相关；同样，单独接受放疗（p=0.031，风险比 0.19，95%CI 0.04-0.86）或单独接受化疗（p=0.053，风险比 0.54，95%CI 0.29-1.01）的患者复发风险明显高于接受多模式治疗的患者。多模式治疗、化疗和放疗的 3 年无复发生存率分别为 86.5%、65.8%和 44.1%。多因素分析显示，年龄和分级是无复发生存的独立相关因素。与单独化疗相比，多模式治疗的无复发生存风险比为 0.14（95%CI 0.02-1.04），与单独放疗相比，风险比为 0.20（95%CI 0.04-1.11）。