Harano Kenichi, Hirakawa Akihiro, Yunokawa Mayu, Nakamura Toshiaki, Satoh Toyomi, Nishikawa Tadaaki, Aoki Daisuke, Ito Kimihiko, Ito Kiyoshi, Nakanishi Toru, Susumu Nobuyuki, Takehara Kazuhiro, Watanabe Yoh, Watari Hidemichi, Saito Toshiaki
Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan.
Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
Gynecol Oncol. 2016 Jun;141(3):447-453. doi: 10.1016/j.ygyno.2016.04.004. Epub 2016 Apr 14.
The benefits of cytoreductive surgery for uterine carcinosarcoma (UCS) are unknown. The objective of this study was to determine the impact of optimal surgery on advanced UCS patient survival.
We performed a multi-institutional, retrospective study of women diagnosed with stage IIIIV UCS between 2007 and 2012. Data were obtained retrospectively from medical records, including demographic, clinicopathologic, treatment, and outcome information. Optimal cytoreductive surgery was defined as surgery resulting in a maximum residual tumor of ≤1cm. The Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS), and the Cox regression model was used to examine the impact of selected factors on survival.
A total of 225 UCS patients (median age, 63years) were identified, including 136 (60%) with stage III and 89 (40%) with stage IV disease. Among these patients, 170 (76%) received optimal cytoreductive surgery. The median follow-up time was 19months. The median PFS was 11.5months (95% confidence interval [CI], 10.6-13.4) and 8.1months (95% CI, 5.1-9.5) for patients who received optimal and suboptimal cytoreductive surgery, respectively (P<0.0001). The median OS was 37.9months (95% CI, 28.3-not reached) and 18months (95% CI, 9.6-21) for patients who received optimal and suboptimal cytoreductive surgery, respectively (P<0.0001). Residual tumor >1cm was associated with worse OS while pelvic lymph node dissection was associated with improved OS.
Optimal cytoreductive surgery and pelvic lymph node dissection are associated with improved OS in advanced UCS patients.
减瘤手术对子宫癌肉瘤（UCS）的益处尚不清楚。本研究的目的是确定最佳手术对晚期UCS患者生存的影响。
我们对2007年至2012年间诊断为III/IV期UCS的女性进行了一项多机构回顾性研究。数据通过回顾医疗记录获得，包括人口统计学、临床病理、治疗和结局信息。最佳减瘤手术定义为术后最大残留肿瘤≤1cm。采用Kaplan-Meier法计算无进展生存期（PFS）和总生存期（OS），并使用Cox回归模型检验所选因素对生存的影响。
共确定了225例UCS患者（中位年龄63岁），其中136例（60%）为III期，89例（40%）为IV期疾病。在这些患者中，170例（76%）接受了最佳减瘤手术。中位随访时间为19个月。接受最佳和次最佳减瘤手术的患者的中位PFS分别为11.5个月（95%置信区间[CI]，10.6 - 13.4）和8.1个月（95%CI，5.1 - 9.5）（P<0.0001）。接受最佳和次最佳减瘤手术的患者的中位OS分别为37.9个月（95%CI，28.3 - 未达到）和18个月（95%CI，9.6 - 21）（P<0.0001）。残留肿瘤>1cm与较差的OS相关，而盆腔淋巴结清扫与改善的OS相关。
最佳减瘤手术和盆腔淋巴结清扫与晚期UCS患者OS的改善相关。
