Boothe Dustin, Orton Andrew, Odei Bismarck, Stoddard Gregory, Suneja Gita, Poppe Matthew M, Werner Theresa L, Gaffney David K
Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT, United States.
David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
Gynecol Oncol. 2016 Jun;141(3):421-427. doi: 10.1016/j.ygyno.2016.03.021. Epub 2016 Apr 2.
We aimed to investigate the patterns-of-care and overall survival (OS) benefit of aCRT versus adjuvant monotherapy (aMT), defined as either chemotherapy or radiation alone, utilizing a large national registry of patients.
Adult patients with stage III endometrial adenocarcinoma diagnosed from 2004 to 2013 were included. Logistic and Cox regression modeling was used to identify factors predictive of receipt of aCRT and OS, respectively. Survival analysis was performed with Kaplan Meier and log-rank analysis. Propensity score matching and sensitivity analysis was performed to address selection bias and presence of potential confounding variables.
A total of 21,027 patients were identified: 11,435 (54.4%) patients received aMT, while 9592 (45.6%) received aCRT. Utilization of aCRT increased over the study period (p<0.01). Factors predictive of receiving aCRT include private insurance (OR: 1.67, 95% CI: 1.30-2.14), Medicare (OR: 1.33, 95% CI: 1.01-1.75), FIGO stage IIIC disease (OR: 1.36, 95% CI: 1.19-1.54), lymphovascular space invasion (OR: 1.14, 95% CI: 1.03-1.27), and lymph node surgery performed (OR: 1.42, 95% CI: 1.15-1.74). Median survival in years for aCRT, RT, and CT was 10.3, 7.1, and 5.6, respectively (p<0.001). Compared to aMT, aCRT was associated with a decrease risk of death on multivariate analysis (HR: 0.62, 95% CI: 0.56-0.70). The benefit of aCRT over aMT persisted after propensity score matching.
The use of aCRT for stage III endometrial cancer is increasing. Multiple clinical and demographic factors were predictive of aCRT use. When compared to chemotherapy or radiation alone, aCRT is associated with an OS benefit.
我们旨在利用一个大型全国患者登记系统，调查同步放化疗（aCRT）与辅助单药治疗（aMT，定义为单纯化疗或单纯放疗）的治疗模式及总生存（OS）获益情况。
纳入2004年至2013年诊断为III期子宫内膜腺癌的成年患者。分别采用逻辑回归和Cox回归模型来确定预测接受aCRT和OS的因素。采用Kaplan-Meier法和对数秩检验进行生存分析。进行倾向得分匹配和敏感性分析以解决选择偏倚和潜在混杂变量的存在问题。
共识别出21027例患者：11435例（54.4%）患者接受aMT，而9592例（45.6%）接受aCRT。在研究期间，aCRT的使用有所增加（p<0.01）。预测接受aCRT的因素包括私人保险（比值比：1.67，95%置信区间：1.30-2.14）、医疗保险（比值比：1.33，95%置信区间：1.01-1.75）、国际妇产科联盟（FIGO）IIIC期疾病（比值比：1.36，95%置信区间：1.19-1.54）、淋巴管间隙浸润（比值比：1.14，95%置信区间：1.03-1.27）以及进行了淋巴结手术（比值比：1.42，95%置信区间：1.15-1.74）。aCRT、放疗（RT）和化疗（CT）的中位生存年数分别为10.3、7.1和5.6（p<0.001）。多因素分析显示，与aMT相比，aCRT与死亡风险降低相关（风险比：0.62，95%置信区间：0.56-0.70）。倾向得分匹配后，aCRT相对于aMT的获益仍然存在。
III期子宫内膜癌患者使用aCRT的情况正在增加。多种临床和人口统计学因素可预测aCRT的使用。与单纯化疗或单纯放疗相比，aCRT与总生存获益相关。
