老年晚期高级别子宫内膜癌的管理
Management for Elderly Women With Advanced-Stage, High-Grade Endometrial Cancer.
作者信息
Rauh-Hain J Alejandro, Pepin Kristen J, Meyer Larissa A, Clemmer Joel T, Lu Karen H, Rice Laurel W, Uppal Shitanshu, Schorge John O, Del Carmen Marcela G
机构信息
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Gynecologic Oncology and Reproductive Medicine, the University of Texas MD Anderson Cancer Center, Houston, Texas; the Department of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; and the Division of Gynecologic Oncology, Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
出版信息
Obstet Gynecol. 2015 Dec;126(6):1198-1206. doi: 10.1097/AOG.0000000000001140.
OBJECTIVE
To examine the treatment and survival of elderly women diagnosed with advanced-stage, high-grade endometrial cancer.
METHODS
We performed a retrospective cohort study of women diagnosed between 2003 and 2011 with advanced-stage, high-grade endometrial cancers (grade 3 adenocarcinoma, carcinosarcoma, clear-cell carcinoma, and uterine serous carcinoma) using the National Cancer Database. Women were stratified by age: younger than 55, 55-64, 65-74, 75-84, and 85 years old or older. Multivariate logistic regression models and Cox proportional hazards survival methods for all-cause mortality were used for analyses.
RESULTS
Twenty thousand four hundred sixty-eight patients were included, 14.9% younger than 55 years, 30.9% 55-64 years, 31.1% 65-74 years, 18.8% 75-84 years, and 4.3% 85 years old or older. Patients younger than 55 years had surgery more frequently compared with patients 75-84 years (97.2% compared with 95.8%; P<.001) and 85 years or older (97.2% compared with 94.8%; P<.001) and a higher rate of lymph node dissection (78.7% compared with 70.5%; P<.001 and 78.7% compared with 59.5%; P<.001, respectively). Women younger than 55 years old were more likely to receive chemotherapy compared with those 75-84 years (63.9% compared with 42.2%; P<.001) and 85 years old or older (63.9% compared with 22%; P<.001). After adjusting for prognostic factors, women ages 75-84 and 85 years or older were less likely to have received chemotherapy compared with women younger than 55 years (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.29-0.38 and OR 0.12, 95% CI 0.10-0.14). The same was true with surgery (OR 0.63, 95% CI 0.45-0.88 and OR 0.46, 95% CI 0.30-0.70) and radiotherapy (OR 0.61, 95% CI 0.53-0.70 and OR 0.45, 95% CI 0.37-0.56). The Cox regression model showed that in women with stage III disease, women 75-84 years had a twofold higher risk of death (hazard ratio [HR] 2.38, 95% CI 2.14-2.65) and those 85 years or older had a threefold higher risk (HR 3.16, 95% CI 2.76-3.61) compared with patients younger than 55 years. Patients with stage IV and age 75-84 years had a 24% increased risk of death (HR 1.24, 95% CI 1.11-1.40) and those 85 years or older had a 52% increased risk (HR 1.52, 95% CI 1.29-1.79).
CONCLUSION
Elderly women with high-grade endometrial cancer are less likely to be treated with surgery, chemotherapy, or radiation.
LEVEL OF EVIDENCE
II.
目的
研究确诊为晚期、高级别子宫内膜癌的老年女性的治疗及生存情况。
方法
我们利用国家癌症数据库对2003年至2011年间确诊为晚期、高级别子宫内膜癌（3级腺癌、癌肉瘤、透明细胞癌和子宫浆液性癌）的女性进行了一项回顾性队列研究。女性按年龄分层：小于55岁、55 - 64岁、65 - 74岁、75 - 84岁以及85岁及以上。采用多变量逻辑回归模型和全因死亡率的Cox比例风险生存方法进行分析。
结果
共纳入2468例患者，14.9%小于55岁，30.9%为55 - 64岁，31.1%为65 - 74岁，18.8%为75 - 84岁，4.3%为85岁及以上。与75 - 84岁（97.2%对95.8%；P <.001）和85岁及以上（97.2%对94.8%；P <.001）的患者相比，小于55岁的患者手术频率更高，且淋巴结清扫率更高（78.7%对70.5%；P <.001以及78.7%对59.5%；P <.001）。与75 - 84岁（63.9%对42.2%；P <.001）和85岁及以上（63.9%对22%；P <.001）的女性相比，小于55岁的女性更有可能接受化疗。在调整预后因素后，75 - 84岁和85岁及以上的女性接受化疗的可能性低于小于55岁的女性（比值比[OR] 0.34，95%置信区间[CI] 0.29 - 0.38以及OR 0.12，95% CI 0.10 - 0.14）。手术（OR 0.63，95% CI 0.45 - 0.88以及OR 0.46，95% CI 0.30 - 0.70）和放疗（OR 0.61，95% CI 0.53 - 0.70以及OR 0.45，95% CI 0.37 - 0.56）情况也是如此。Cox回归模型显示，在III期疾病的女性中，75 - 84岁的女性死亡风险高出两倍（风险比[HR] 2.38，95% CI 2.14 - 2.65），85岁及以上的女性死亡风险高出三倍（HR 3.16，95% CI 2.76 - 3.61），与小于55岁的患者相比。IV期且年龄在75 - 84岁的患者死亡风险增加24%（HR 1.24，95% CI 1.11 - 1.40），85岁及以上的患者死亡风险增加52%（HR 1.52，95% CI 1.29 - 1.79）。
结论
患有高级别子宫内膜癌的老年女性接受手术、化疗或放疗的可能性较小。
证据级别
II级。
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