Shaikh Talha, Churilla Thomas M, Mantia-Smaldone Gina M, Chu Christina, Rubin Stephen C, Anderson Penny R
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States.
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States.
Gynecol Oncol. 2016 Jun;141(3):434-439. doi: 10.1016/j.ygyno.2016.04.010. Epub 2016 Apr 21.
The purpose of this study was to examine the impact of adjuvant radiation on overall survival (OS) and cancer specific survival (CSS) in patients with lymph node (LN) positive endometrial cancer.
We analyzed all women diagnosed with FIGO stage IIIC endometrial adenocarcinoma in the Surveillance, Epidemiology, and End Results database from 2004 to 2012 (n=2177). Patients not undergoing surgery or with missing treatment information were excluded. Chi-squared tests were used to compare predictors of treatment received. Cox proportional hazards model and Kaplan-Meier method were used to assess OS and CSS.
The median age was 60 (27-84) and the median follow-up was 31months (2-107). Adjuvant radiation was administered to 1248 (60.3%) patients. A total of 1363 (65.9%) patients had pelvic LN involvement while 658 (31.8%) had para-aortic involvement. The 3-year actuarial OS for patients with and without radiation was 80.5% and 67.6%, respectively (p<0.001). The 3-year actuarial CSS for patients with and without radiation was 83.4% and 73%, respectively (p<0.001). On multivariable analysis, receipt of radiotherapy remained associated with OS (HR 0.61 95% CI 0.51-0.74) and CSS (HR 0.65, 95% CI 0.53-0.80). After propensity matching, radiotherapy continued to be associated with an improved OS (HR 0.65 95% CI 0.54-0.78) and CSS (HR 0.65 95% CI 0.53-0.81). The addition of brachytherapy was not associated with OS or CSS.
In this large population registry analysis, adjuvant radiation was associated with improved OS and CSS in patients with LN positive endometrial cancer. Prospective data is needed to confirm these findings.
本研究旨在探讨辅助放疗对淋巴结（LN）阳性子宫内膜癌患者总生存期（OS）和癌症特异性生存期（CSS）的影响。
我们分析了2004年至2012年监测、流行病学和最终结果数据库中所有诊断为国际妇产科联盟（FIGO）IIIC期子宫内膜腺癌的女性（n = 2177）。未接受手术或治疗信息缺失的患者被排除。采用卡方检验比较接受治疗的预测因素。采用Cox比例风险模型和Kaplan-Meier方法评估OS和CSS。
中位年龄为60岁（27 - 84岁），中位随访时间为31个月（2 - 107个月）。1248例（60.3%）患者接受了辅助放疗。共有1363例（65.9%）患者有盆腔淋巴结受累，658例（31.8%）患者有腹主动脉旁淋巴结受累。接受放疗和未接受放疗患者的3年精算OS分别为80.5%和67.6%（p < 0.001）。接受放疗和未接受放疗患者的3年精算CSS分别为83.4%和73%（p < 0.001）。多变量分析显示，接受放疗仍与OS（风险比[HR] 0.61，95%置信区间[CI] 0.51 - 0.74）和CSS（HR 0.65，95% CI 0.53 - 0.80）相关。倾向评分匹配后，放疗继续与改善的OS（HR 0.65，95% CI 0.54 - 0.78）和CSS（HR 0.65，95% CI 0.53 - 0.81）相关。近距离放疗的加入与OS或CSS无关。
在这项大型人群登记分析中，辅助放疗与LN阳性子宫内膜癌患者的OS和CSS改善相关。需要前瞻性数据来证实这些发现。
