Lester-Coll Nataniel H, Young Melissa R, Park Henry S, Ratner Elena S, Litkouhi Babak, Damast Shari
Departments of *Therapeutic Radiology and †Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
Int J Gynecol Cancer. 2017 Nov;27(9):1904-1911. doi: 10.1097/IGC.0000000000001095.
Radiotherapy (RT) is an established adjuvant treatment for stage II endometrioid endometrial carcinoma (EEC). The role of chemotherapy (CT) in stage II EEC is less proven. We used the National Cancer Data Base to identify factors associated with adjuvant CT in stage II EEC and to explore whether receipt of CT was associated with improved overall survival (OS).
METHODS/MATERIALS: Women diagnosed in 2010 to 2013 with International Federation of Obstetrics and Gynecology stage II EEC (grades 1-3) after hysterectomy and bilateral salpingo-oophorectomy were identified in the National Cancer Data Base. Multivariable logistic regression was used to identify covariates associated with receipt of CT. Overall survival among patients receiving RT, CT, or chemoradiotherapy (CRT) after surgery was compared using Kaplan-Meier estimates, the log-rank test, Cox proportional hazards regression, and propensity score matching.
We identified 6102 stage II EEC patients. There were 358 patients (6%) who received adjuvant CT alone and 525 (9%) who received CRT; the remainder received RT alone (n = 1906; 31%) or no adjuvant treatment (n = 3313; 54%). The presence of lymphovascular invasion (odds ratio, 3.58; P < 0.001) and grade 3 disease (odds ratio, 3.40; P < 0.001) was strongly associated with receipt of CT or CRT. The OS at 3 years for the entire cohort was 89%. On multivariable analysis, CT versus RT was associated with worse OS (hazard ratio [HR], 2.12 [95% confidence interval, 1.46-3.06]; P < 0.001), whereas CRT versus RT was not associated with improved OS (HR, 1.07 [95% confidence interval, 0.71-1.62]; P = 0.781). After propensity score matching, there remained no difference in OS between RT and CRT (HR, 1.14; P = 0.614).
Patients with stage II EEC have an excellent prognosis, and most undergo observation or receive adjuvant RT in the United States. Receipt of CT (alone or with RT) was not associated with an OS advantage compared with RT alone in this observational cohort. Randomized trials will help clarify the role of CT in stage II patients.
放射治疗（RT）是II期子宫内膜样腺癌（EEC）既定的辅助治疗方法。化疗（CT）在II期EEC中的作用尚未得到充分证实。我们利用国家癌症数据库来确定与II期EEC辅助性CT相关的因素，并探讨接受CT是否与总生存期（OS）改善相关。
方法/材料：在国家癌症数据库中确定2010年至2013年诊断为国际妇产科联盟II期EEC（1 - 3级）且接受子宫切除及双侧输卵管卵巢切除术后的女性。采用多变量逻辑回归来确定与接受CT相关的协变量。使用Kaplan-Meier估计、对数秩检验、Cox比例风险回归和倾向得分匹配比较术后接受RT、CT或放化疗（CRT）患者的总生存期。
我们确定了6102例II期EEC患者。有358例患者（6%）仅接受辅助性CT，525例患者（9%）接受CRT；其余患者仅接受RT（n = 1906；31%）或未接受辅助治疗（n = 3313；54%）。存在淋巴管浸润（比值比，3.58；P < 0.001）和3级疾病（比值比，3.40；P < 0.001）与接受CT或CRT密切相关。整个队列3年时的OS为89%。在多变量分析中，CT与RT相比与较差的OS相关（风险比[HR]，2.12 [95%置信区间，1.46 - 3.06]；P < 0.001），而CRT与RT相比与OS改善无关（HR，1.07 [95%置信区间，0.71 - 1.62]；P = 0.781）。在倾向得分匹配后，RT和CRT之间的OS仍无差异（HR，1.14；P = 0.614）。
II期EEC患者预后良好，在美国大多数患者接受观察或辅助性RT。在这个观察性队列中，与仅接受RT相比，接受CT（单独或与RT联合）与OS优势无关。随机试验将有助于阐明CT在II期患者中的作用。
