多中心评估辅助治疗在完全切除的 IIIC 期子宫内膜癌患者中的应用。

A multicenter evaluation of adjuvant therapy in women with optimally resected stage IIIC endometrial cancer.

机构信息

Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA.

Gynecologic Oncology, The University of Minnesota, Minneapolis, MN, USA.

出版信息

Gynecol Oncol. 2013 Jan;128(1):65-70. doi: 10.1016/j.ygyno.2012.10.010. Epub 2012 Oct 17.

DOI:10.1016/j.ygyno.2012.10.010

PMID:23085460

Abstract

OBJECTIVE

To determine if there is an advantage to combination chemotherapy and radiation for optimally resected stage IIIC endometrial cancer (EC).

METHODS

A multicenter retrospective analysis of patients with EC from 1991 to 2008 was conducted. Inclusion criteria were lymph node assessment and optimally resected disease. Recurrence-free (RFS) and overall survival (OS) were analyzed using Kaplan-Meier method and Cox proportional hazards model.

RESULTS

265 patients with optimally resected stage IIIC EC were identified. Postoperative therapies included radiotherapy in 17% (n=45), chemotherapy in 17% (n=46), and both chemotherapy and radiation in 61% (n=161). Three-year RFS was 56% for chemotherapy alone, compared to 73% for radiation alone, and 73% for combination therapy (p=0.12). Those receiving chemotherapy alone had the worst 3-year OS (78%) compared to either radiotherapy alone (95%) or combination therapy (90%) (p=0.005). After adjustment for stage and grade those treated with chemotherapy alone were at a 2.2 fold increased risk of recurrence (95% CI, 1.2 to 4.2; p=0.02) and 4.0 fold increased risk of death (95% CI, 1.6 to 10.0; p=0.004) compared to those treated with chemotherapy and radiation. In contrast there was no significant difference in RFS [HR=1.0 (95% CI, 0.5 to 2.0; p=0.92)] or OS [HR=1.1 (95% CI, 0.3 to 3.6; p=0.91)] for those treated with radiation alone compared to those treated with chemotherapy and radiation.

CONCLUSION

Adjuvant therapy with either radiation alone or chemotherapy and radiation was associated with improved outcomes for patients with optimally resected stage IIIC EC compared to those treated with chemotherapy only.

摘要

目的

确定对于最佳切除的 IIIC 期子宫内膜癌（EC）患者，联合化疗和放疗是否具有优势。

方法

对 1991 年至 2008 年期间患有 EC 的患者进行了多中心回顾性分析。纳入标准为淋巴结评估和最佳切除的疾病。使用 Kaplan-Meier 方法和 Cox 比例风险模型分析无复发生存（RFS）和总生存（OS）。

结果

确定了 265 名最佳切除的 IIIC 期 EC 患者。术后治疗包括放疗占 17%（n=45），化疗占 17%（n=46），化疗和放疗联合占 61%（n=161）。单独化疗的 3 年 RFS 为 56%，单独放疗为 73%，联合治疗为 73%（p=0.12）。单独接受化疗的患者 3 年 OS 最差（78%），与单独放疗（95%）或联合治疗（90%）相比（p=0.005）。在调整了分期和分级后，单独接受化疗的患者复发风险增加了 2.2 倍（95%CI，1.2 至 4.2；p=0.02），死亡风险增加了 4.0 倍（95%CI，1.6 至 10.0；p=0.004），与接受化疗和放疗的患者相比。相比之下，单独接受放疗的患者的 RFS[HR=1.0（95%CI，0.5 至 2.0；p=0.92）]或 OS[HR=1.1（95%CI，0.3 至 3.6；p=0.91）]与接受化疗和放疗的患者相比，没有显著差异。