Holman Laura L, Pal Navdeep, Iglesias David A, Soliman Pamela T, Balakrishnan Nyla, Klopp Ann, Broaddus Russell R, Fleming Nicole D, Munsell Mark F, Lu Karen H, Westin Shannon N
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Gynecol Oncol. 2017 Jul;146(1):27-33. doi: 10.1016/j.ygyno.2017.04.018. Epub 2017 Apr 30.
The study objective was to analyze the impact of prognostic factors, including treatment modality, on outcome in patients with advanced-stage uterine serous carcinoma (USC).
A retrospective review of patients diagnosed with stage III or IV USC between 1993 and 2012 was performed. Summary statistics were used to describe demographic and clinical characteristics. Overall survival (OS) and recurrence free survival (RFS) were estimated by Kaplan-Meier analysis. Cox proportional hazards regression was used to model the association of potential prognostic factors with OS and RFS.
The study included 260 patients with median follow-up of 26.6months (range 1-172.8). Median age was 63years (range 30-88) and 52.3% had stage III disease. In all, 60% were treated with surgery followed by chemotherapy, 18.1% received surgery, chemotherapy, and radiotherapy, 11.5% had surgery and radiotherapy, and 10.4% had neoadjuvant chemotherapy. The overall complete response rate was 68.9%, and the cumulative incidence of recurrence was 82.7%. Treatment that included surgery, chemotherapy, and radiation and stage III disease were associated with improved RFS on multivariate analysis. For OS, therapy with surgery, chemotherapy, and radiation, mixed histology, and stage III disease were associated with better OS on multivariate analysis.
Patients with advanced-stage USC have a poor prognosis, regardless of clinical factors or treatment received. However, combination therapy that includes chemotherapy and radiation appears to be associated with improved survival in these women.
本研究旨在分析包括治疗方式在内的预后因素对晚期子宫浆液性癌（USC）患者预后的影响。
对1993年至2012年间诊断为III期或IV期USC的患者进行回顾性研究。采用汇总统计描述人口统计学和临床特征。通过Kaplan-Meier分析估计总生存期（OS）和无复发生存期（RFS）。使用Cox比例风险回归模型分析潜在预后因素与OS和RFS的关联。
本研究纳入260例患者，中位随访时间为26.6个月（范围1 - 172.8个月）。中位年龄为63岁（范围30 - 88岁），52.3%的患者为III期疾病。总体而言，60%的患者接受手术加化疗，18.1%接受手术、化疗和放疗，11.5%接受手术和放疗，10.4%接受新辅助化疗。总体完全缓解率为68.9%，复发累积发生率为82.7%。多因素分析显示，包括手术、化疗和放疗的治疗方式以及III期疾病与改善的RFS相关。对于OS，多因素分析显示手术、化疗和放疗、混合组织学以及III期疾病的治疗与更好的OS相关。
晚期USC患者预后较差，无论临床因素或接受的治疗如何。然而，包括化疗和放疗的联合治疗似乎与这些女性的生存期改善相关。
