Gockley Allison A, Rauh-Hain J Alejandro, Anders Amber M, Meyer Larissa A, Clemmer Joel, Lu Karen H, Clark Rachel M, Schorge John O, del Carmen Marcela G
*Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and †Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M D Anderson Cancer Center, Houston, TX.
Int J Gynecol Cancer. 2016 May;26(4):697-704. doi: 10.1097/IGC.0000000000000661.
The aim of the study was to examine the patterns of care and the impact of chemotherapy and radiation on survival in women diagnosed with uterine clear cell carcinoma (UCCC). The primary outcomes of this analysis were receipt of treatment within 6 months of diagnosis and overall survival.
Women diagnosed with UCCC from 2003 to 2011 were identified through the National Cancer Data Base. Standard univariate and multivariable analyses with logistic regression were performed. Kaplan-Meier survival analysis was used to generate overall survival data. Factors predictive of outcome were evaluated using the log-rank test and Cox proportional hazards model.
A total of 3212 patients were identified. Chemotherapy, radiation, and combination chemotherapy and radiation were administered in 23.3%, 19.7%, and 11.1% of women, respectively. After adjusting for age, race, socioeconomic status, facility type, stage, surgery, lymph node dissection, comorbidity index, period of diagnosis, and registry location, there was an association between combined chemotherapy and radiation (hazard ratio, 0.74; 95% confidence interval, 0.61-0.90) with improved survival. Adjuvant therapy was not associated with improved survival among patients with early-stage disease (stages I and II). Both chemotherapy and combined chemotherapy and radiation were associated with significantly improved survival among patients with advanced-stage disease (stages III and IV).
In patients with early-stage UCCC, adjuvant therapy was not associated with significantly improved survival. Chemotherapy and combination of chemotherapy and radiation were associated with improved survival in patients with advanced-stage UCCC.
本研究旨在探讨子宫透明细胞癌（UCCC）女性患者的治疗模式以及化疗和放疗对生存的影响。该分析的主要结局为确诊后6个月内接受治疗情况及总生存期。
通过国家癌症数据库识别出2003年至2011年期间确诊为UCCC的女性患者。进行了标准的单变量和多变量逻辑回归分析。采用Kaplan-Meier生存分析生成总生存期数据。使用对数秩检验和Cox比例风险模型评估预测结局的因素。
共识别出3212例患者。分别有23.3%、19.7%和11.1%的女性接受了化疗、放疗以及化疗联合放疗。在调整年龄、种族、社会经济地位、医疗机构类型、分期、手术、淋巴结清扫、合并症指数、诊断时期和登记地点后，化疗联合放疗与生存改善之间存在关联（风险比，0.74；95%置信区间，0.61 - 0.90）。辅助治疗与早期疾病（I期和II期）患者的生存改善无关。化疗以及化疗联合放疗均与晚期疾病（III期和IV期）患者的生存显著改善相关。
在早期UCCC患者中，辅助治疗与生存的显著改善无关。化疗以及化疗联合放疗与晚期UCCC患者的生存改善相关。
