Rauh-Hain Jose Alejandro, Connor Sarah C, Clemmer Joel T, Foley Olivia W, Clark Rachel M, Hall Tracilyn R, Boruta David M, Schorge John O, del Carmen Marcela G
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Int J Gynecol Cancer. 2015 Jul;25(6):1023-30. doi: 10.1097/IGC.0000000000000464.
The objectives of this study were to evaluate the rates of chemotherapy and radiotherapy delivery in the treatment of uterine serous carcinoma in the Medicare population and to compare clinical outcomes in treated and untreated patients.
The linked Surveillance, Epidemiology, and End Results and Medicare databases were queried to identify patients with a diagnosis of uterine serous carcinoma between 1992 and 2009. The impact of chemotherapy on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model.
A total of 2188 patients met study eligibility criteria. Stages I, II, III, and IV diseases accounted for 890 (41%), 174 (8%), 470 (21%), and 654 (30%) of the study population, respectively. Chemotherapy, radiotherapy, both, or none, were administered as adjuvant therapy in 635 (29%), 536 (24%), 308 (14%), and 709 (32%) of the study population, respectively. Use of chemotherapy became more frequent over time. Over the study period, and after adjusting for race, time of diagnosis, SEER registry, marital status, stage, age, surgery, lymph node dissection, socioeconomic status, and comorbidity index, there was an association between receipt of radiotherapy alone (hazard ratio [HR], 1.3; 95% CI, 1.04-1.67) and not receiving any treatment (HR, 1.5; 95% CI, 1.2-2.01) and worst survival. Survival was not improved over time.
Although adjuvant chemotherapy and combination treatment with chemotherapy and radiation were associated with improved survival in our model, there was no significant improvement in survival over time.
本研究的目的是评估医疗保险人群中子宫浆液性癌治疗的化疗和放疗实施率，并比较接受治疗和未接受治疗患者的临床结局。
查询关联的监测、流行病学和最终结果数据库以及医疗保险数据库，以识别1992年至2009年间诊断为子宫浆液性癌的患者。使用Kaplan-Meier方法分析化疗对生存的影响。使用Cox比例风险模型比较预测结局的因素。
共有2188名患者符合研究纳入标准。研究人群中I期、II期、III期和IV期疾病分别占890例（41%）、174例（8%）、470例（21%）和654例（30%）。分别有635例（29%）、536例（24%）、308例（14%）和709例（32%）的研究人群接受了化疗、放疗、放化疗联合或未接受任何辅助治疗。随着时间的推移，化疗的使用变得更加频繁。在研究期间，在调整种族、诊断时间、监测、流行病学和最终结果登记处、婚姻状况、分期、年龄、手术、淋巴结清扫、社会经济地位和合并症指数后，单独接受放疗（风险比[HR]，1.3；95%可信区间，1.04-1.67）和未接受任何治疗（HR，1.5；95%可信区间，1.2-2.01）与最差的生存率相关。随着时间的推移，生存率没有提高。
尽管在我们的模型中辅助化疗以及化疗与放疗联合治疗与生存率提高相关，但随着时间的推移生存率并没有显著提高。
