多模态治疗与淋巴结阳性（III 期）子宫乳头状浆液性癌女性生存优势相关：一项国家癌症数据库研究。

Survival advantage associated with multimodal therapy in women with node-positive (stage-IIIC) uterine papillary serous carcinoma: a National Cancer Database study.

机构信息

Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.

Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.

出版信息

BJOG. 2016 Oct;123(11):1846-52. doi: 10.1111/1471-0528.13726. Epub 2015 Nov 5.

DOI:10.1111/1471-0528.13726

PMID:26537059

Abstract

OBJECTIVE

Uterine papillary serous carcinoma (UPSC) is an aggressive subtype of endometrial cancer. Adjuvant chemotherapy (CT) has become standard care in treatment of women with advanced-stage UPSC, but the role of consolidative radiotherapy (RT) is unclear. This study aims to evaluate survival outcomes of multimodal therapy.

DESIGN

Retrospective cohort study using a National Cancer Database (NCDB).

SETTING

United States of America.

SAMPLE

A total of 1816 women diagnosed with UPSC.

METHODS

All women diagnosed with surgically staged FIGO (International Federation of Gynecology and Obstetrics) stage-IIIC UPSC were identified in the NCDB from January 1998 to December 2010. Overall survival (OS) was estimated using the Kaplan-Meier method. Univariate and multivariable analyses were performed to identify and control for prognostic factors.

MAIN OUTCOME MEASURE

Overall survival.

RESULTS

A total of 398 057 cases of uterine cancer were identified, 22 106 of which were UPSC. Of these women, 14 093 underwent lymph-node examination, 2902 (20.6%) were found to have stage-IIIC disease, and 1816 received chemotherapy. Younger age and higher number of total lymph nodes examined were independently predictive of receiving multimodality (CT + RT) therapy, compared with CT only. Median OS was 33.6 and 42.6 months, for the CT and CT + RT groups, respectively (P < 0.0005). Exploratory univariate analyses found age, comorbidity index, tumour size, and number of dissected and positive lymph nodes to be also associated with survival. Multivariable analysis controlling for the above found the use of consolidative radiotherapy to be independently predictive of improved OS, with a hazard ratio of 0.69 (95% confidence interval, 95% CI 0.56-0.84).

CONCLUSIONS

Patients with stage-IIIC UPSC may benefit from multimodal treatment that includes adjuvant radiotherapy in addition to chemotherapy.

TWEETABLE ABSTRACT

In this study of 1816 women with uterine papillary serous cancer, adjuvant radiotherapy increased survival.

摘要

目的

子宫乳头状浆液性癌（UPSC）是子宫内膜癌的一种侵袭性亚型。辅助化疗（CT）已成为治疗晚期 UPSC 女性的标准治疗方法，但巩固性放疗（RT）的作用尚不清楚。本研究旨在评估多模式治疗的生存结果。

设计

使用国家癌症数据库（NCDB）进行回顾性队列研究。

地点

美利坚合众国。

样本

共 1816 名诊断为 UPSC 的女性。

方法

从 1998 年 1 月至 2010 年 12 月，在 NCDB 中确定所有接受手术分期为国际妇产科联合会（FIGO）IIIC 期 UPSC 的女性。使用 Kaplan-Meier 法估计总生存期（OS）。进行单变量和多变量分析，以确定和控制预后因素。

主要观察指标

总生存期。

结果

共确定了 398057 例子宫癌病例，其中 22106 例为 UPSC。这些女性中有 14093 例行淋巴结检查，2902 例（20.6%）发现为 IIIC 期疾病，1816 例接受化疗。与仅接受 CT 相比，年轻和更多的总淋巴结检查数与接受多模式（CT+RT）治疗独立相关。CT 和 CT+RT 组的中位 OS 分别为 33.6 和 42.6 个月（P<0.0005）。探索性单变量分析发现年龄、合并症指数、肿瘤大小以及切除和阳性淋巴结的数量也与生存相关。多变量分析控制上述因素后发现，使用巩固性放疗可独立预测 OS 改善，风险比为 0.69（95%置信区间，95%CI 0.56-0.84）。