Department of Gynaecological Oncology, University College London Hospitals, 250 Euston Rd., London, United Kingdom.
Int J Gynecol Cancer. 2013 Jul;23(6):1056-64. doi: 10.1097/IGC.0b013e3182978328.
As adjuvant treatment of advanced-stage endometrial cancer remains undefined, we sought to review and describe the outcomes of patients with International Federation of Obstetrics and Gynecology stage III endometrial cancer treated with chemotherapy and/or radiotherapy after primary surgery.
We conducted a retrospective cohort study of patients with stage III disease treated at University College London Hospitals from 2002 to 2009. Patients were eligible if they received adjuvant treatment at our center. We excluded those with any synchronous gynecologic tumor and patients who underwent surgery but not adjuvant treatment at the center.
Stages IIIA, IIIB, and IIIC tumors accounted for 60%, 10%, and 30%, respectively. The median age was 67 years (range, 37-94 years). Sixty-five percent were pure endometrioid tumors, and 65% were high-grade (grade 3) tumors. Eighty-one patients received adjuvant treatment, 9% received chemotherapy alone, 28% received radiotherapy alone, and 63% received sequential combined chemotherapy followed by external beam radiotherapy with vaginal vault brachytherapy. In multivariate analysis, there was a significant difference between the adjuvant treatment groups for disease-free survival (DFS) and overall survival (OS) with those who received chemotherapy (DFS: P = 0.0001; hazard ratio [HR], 6.2; 95% confidence interval [CI], 2.47-15.8; OS: P = 0.003; HR, 6.0; CI, 2.2-16.6) or radiotherapy alone (DFS: P = 0.06; HR, 1.88; CI, 0.97-3.7; OS: P = 0.025; HR, 2.1; CI, 1.1-4.1) having a poorer survival compared to combined treatment. Overall survival at 3 years and 5 years were 57% and 47%, respectively, for all 81 patients who received any adjuvant treatment.
Sequential combined adjuvant chemotherapy and radiotherapy may be associated with a significant improvement in survival compared with chemotherapy or radiotherapy alone. Univariate and multivariate analysis showed that advanced age, high grade, and presence of lymphovascular space invasion were associated with poor DFS and OS. For patients with documented recurrence (n = 41), there was no clear relationship between site of recurrence and type of adjuvant treatment given.
由于晚期子宫内膜癌的辅助治疗仍未确定，我们旨在回顾和描述接受原发性手术后接受化疗和/或放疗的国际妇产科联合会（FIGO）III 期子宫内膜癌患者的结局。
我们对 2002 年至 2009 年在伦敦大学学院医院接受治疗的 III 期疾病患者进行了回顾性队列研究。如果患者在我们中心接受辅助治疗，则有资格入组。我们排除了那些同时患有妇科肿瘤和仅在中心接受手术而未接受辅助治疗的患者。
III A、III B 和 III C 期肿瘤分别占 60%、10%和 30%。中位年龄为 67 岁（范围 37-94 岁）。65%为纯子宫内膜样肿瘤，65%为高级别（3 级）肿瘤。81 例患者接受了辅助治疗，9%接受了单纯化疗，28%接受了单纯放疗，63%接受了序贯联合化疗，随后进行外照射放疗联合阴道穹窿近距离放疗。多因素分析显示，在无病生存（DFS）和总生存（OS）方面，接受化疗（DFS：P=0.0001；风险比[HR]，6.2；95%置信区间[CI]，2.47-15.8；OS：P=0.003；HR，6.0；CI，2.2-16.6）或单纯放疗（DFS：P=0.06；HR，1.88；CI，0.97-3.7；OS：P=0.025；HR，2.1；CI，1.1-4.1）的患者与联合治疗组相比，DFS 和 OS 存在显著差异。所有接受任何辅助治疗的 81 例患者的 3 年和 5 年总生存率分别为 57%和 47%。
与单纯化疗或放疗相比，序贯联合辅助化疗和放疗可能与生存的显著改善相关。单因素和多因素分析表明，高龄、高级别和脉管侵犯与DFS 和 OS 不良相关。对于有记录复发的患者（n=41），复发部位与辅助治疗类型之间没有明确的关系。
