Reynaers Eline Aem, Jutzi Leah, Ezendam Nicole P M, Kwon Janice S, Pijnenborg Johanna M A
*Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg; †Division of Woman and Baby, University Medical Centre Utrecht, The Netherlands; ‡Division of Gynecologic Oncology, University of British Columbia and British Columbia Cancer Agency, Vancouver, Canada; §Comprehensive Cancer Centre The Netherlands, Eindhoven; and ∥Centre of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands.
Int J Gynecol Cancer. 2017 Mar;27(3):467-472. doi: 10.1097/IGC.0000000000000900.
Patients with high-grade endometrioid endometrial carcinoma have a high risk of recurrence, even in early stage. To determine the benefit of a more aggressive adjuvant treatment approach, different treatment strategies of 2 referral centers were compared.
Outcome of all patients with International Federation of Gynecology and Obstetrics IB and II high-grade endometrioid endometrial carcinoma treated between 2008 and 2012, at the Gynecological Oncology Center South (GOCS) were compared with patients treated at the British Columbia Cancer Agency (BCCA). All patients underwent primary surgical treatment. Adjuvant treatment consisted of radiotherapy dependent on final pathology (GOCS), or adjuvant chemotherapy and pelvic radiotherapy (BCCA).
A total of 116 patients were treated at the GOCS (n = 61) and BCCA (n = 55). Patient cohorts were comparable for clinicopathological factors, except for age at diagnosis and lymphadenectomy. Radiotherapy was applied in 70.5% at the GOCS compared with 100% at the BCCA. All BCCA patients received chemotherapy compared with 3.3% at GOCS. The BCCA treatment strategy resulted in a significant reduced recurrence rate when compared with GOCS, 10.9% and 36.1%, respectively. There was no significant difference in the recurrence rate between patients with (n = 48) and without a lymphadenectomy (n = 68). Yet, numbers are relatively low. Because most recurrences were distant 78.6% (22/28), adjuvant chemotherapy resulted in reduced disease-related mortality.
Adjuvant chemotherapy and radiotherapy in early-stage high-grade endometrioid endometrial carcinoma results in improved disease-specific and overall survival compared to radiotherapy alone. Yet, due to the relatively low numbers, validation of these findings is needed in large prospective trials.
高级别子宫内膜样子宫内膜癌患者即使处于早期也有较高的复发风险。为确定更积极的辅助治疗方法的益处，对两个转诊中心的不同治疗策略进行了比较。
比较了2008年至2012年间在南方妇科肿瘤中心（GOCS）治疗的所有国际妇产科联盟（FIGO）IB和II期高级别子宫内膜样子宫内膜癌患者与在不列颠哥伦比亚癌症机构（BCCA）治疗的患者的结局。所有患者均接受了初次手术治疗。辅助治疗包括根据最终病理结果进行放疗（GOCS），或辅助化疗和盆腔放疗（BCCA）。
GOCS治疗了116例患者（n = 61），BCCA治疗了55例患者。除诊断时年龄和淋巴结清扫情况外，两组患者的临床病理因素具有可比性。GOCS有70.5%的患者接受了放疗，而BCCA为100%。所有BCCA患者均接受了化疗，而GOCS为3.3%。与GOCS相比，BCCA的治疗策略使复发率显著降低，分别为10.9%和36.1%。有淋巴结清扫（n = 48）和无淋巴结清扫（n = 68）的患者之间复发率无显著差异。然而，样本量相对较小。由于大多数复发为远处转移（78.6%，22/2），辅助化疗降低了疾病相关死亡率。
与单纯放疗相比，早期高级别子宫内膜样子宫内膜癌的辅助化疗和放疗可改善疾病特异性生存率和总生存率。然而，由于样本量相对较小，这些结果需要在大型前瞻性试验中进行验证。
