Stokes William A, Robin Tyler P, Jackson Matthew W, Amini Arya, Schefter Tracey E, Lefkowits Carolyn C, Fisher Christine M
Department of Radiation Oncology.
Division of Gynecologic Oncology, University of Colorado Denver, Aurora, CO.
Am J Clin Oncol. 2018 Oct;41(10):927-932. doi: 10.1097/COC.0000000000000396.
The objective of this study is to characterize patterns of utilization of adjuvant chemotherapy (CT) and radiotherapy (RT) in the posthysterectomy management of uterine carcinosarcoma (UCS) in the United States.
We queried the National Cancer Database for women diagnosed with UCS between 2004 and 2012 and undergoing hysterectomy. Logistic regression was performed to identify sociodemographic, facility-specific, and treatment-related predictors of receiving multiagent chemotherapy, external beam radiotherapy (EBRT), or brachytherapy (BT).
In total 4272 patients were included, with 2 in 5 (40.5%) receiving no adjuvant therapy. Regarding RT, 2357 (55.1%) received neither EBRT nor BT, 929 (21.7%) received EBRT alone, 518 (12.1%) received BT alone, and 468 (11.0%) received EBRT+BT. Most women (70.8%) received no CT, a minority (1.5%) received single-agent CT, and the rest (27.8%) received multiagent chemotherapy. Logistic regression demonstrated disparities in receipt of adjuvant therapies by age, diagnosis year, insurance, facility volume, facility type, stage, and margin status, with patients with positive surgical margins less likely to receive BT.
Following hysterectomy for UCS, a large proportion of women receives no CT and no RT in the United States. Multispecialty evaluation is critical for individualization of therapy and may address disparities in this aggressive disease.
本研究的目的是描述美国子宫癌肉瘤（UCS）子宫切除术后辅助化疗（CT）和放疗（RT）的使用模式。
我们查询了国家癌症数据库中2004年至2012年间被诊断为UCS并接受子宫切除术的女性患者。进行逻辑回归分析以确定接受多药化疗、外照射放疗（EBRT）或近距离放疗（BT）的社会人口统计学、机构特定因素和治疗相关预测因素。
共纳入4272例患者，五分之二（40.5%）未接受辅助治疗。关于放疗，2357例（55.1%）既未接受EBRT也未接受BT，929例（21.7%）仅接受EBRT，518例（12.1%）仅接受BT，468例（11.0%）接受EBRT+BT。大多数女性（70.8%）未接受CT，少数（1.5%）接受单药CT，其余（27.8%）接受多药化疗。逻辑回归显示，在年龄、诊断年份、保险、机构规模、机构类型、分期和切缘状态方面，辅助治疗的接受情况存在差异，手术切缘阳性的患者接受BT的可能性较小。
在美国，UCS子宫切除术后，很大一部分女性未接受CT和放疗。多专业评估对于个体化治疗至关重要，可能有助于解决这种侵袭性疾病中的差异问题。
