University of Utah, Department of Radiation Oncology, Salt Lake City, UT, United States.
Duke University, Department of Radiation Oncology, Durham, NC, United States.
Gynecol Oncol. 2017 Nov;147(2):320-328. doi: 10.1016/j.ygyno.2017.08.005. Epub 2017 Aug 9.
Elderly women with endometrial cancer are at increased risk of local recurrence and cancer-specific death compared to younger women. We sought to investigate adjuvant radiotherapy (RT) practice patterns and effects on survival in elderly women with endometrial cancer.
Women from the National Cancer Data Base (NCDB) with FIGO IA grade 3 to FIGO IVA endometrial cancer diagnosed from 2004-2013 were included. Chi square analysis was used to compare the elderly (80+) and non-elderly women (18-79) and women who received RT and those that did not. Univariate and multivariate logistic regression were used to determine predictors of receipt of oncologic surgery and adjuvant RT. Univariate and multivariate Cox survival analyses were performed to examine the effect of radiotherapy on survival. Propensity score matching and shared frailty analysis were done in the elderly cohort.
We identified 48,871 women for analysis. Rates of oncologic surgery were higher in the women 80+ compared with rates of adjuvant RT (95% versus 34%). Rates of RT receipt were higher in non-elderly women (48% versus 34%, p<0.001). Age over 80 was a negative predictive factor (OR 0.62, p<0.001) for receipt of adjuvant RT and oncologic surgery (OR 0.81, p=0.03). Adjuvant RT was associated with a decreased risk of death in elderly (HR 0.79, p<0.001) and non-elderly women (HR 0.77, p<0.001).
Endometrial cancer patients over age 80 have similar rates of oncologic surgery as younger women but are significantly less likely to receive adjuvant RT, and this negatively impacts their survival.
与年轻女性相比，老年子宫内膜癌患者局部复发和癌症特异性死亡的风险增加。我们旨在研究辅助放疗（RT）的实践模式及其对老年子宫内膜癌患者生存的影响。
纳入了 2004 年至 2013 年期间国际妇产科联盟（FIGO）IA 级 3 期至 IVA 期子宫内膜癌诊断为的国家癌症数据库（NCDB）的女性。采用卡方分析比较了老年（80 岁以上）和非老年（18-79 岁）女性以及接受 RT 和未接受 RT 的女性。采用单变量和多变量逻辑回归确定接受肿瘤外科治疗和辅助 RT 的预测因素。采用单变量和多变量 Cox 生存分析评估 RT 对生存的影响。在老年队列中进行倾向评分匹配和共享脆弱性分析。
我们确定了 48871 名女性进行分析。80 岁以上女性的肿瘤外科治疗率高于辅助 RT 率（95% 与 34%）。非老年女性接受 RT 的比例较高（48%与 34%，p<0.001）。年龄超过 80 岁是接受辅助 RT 和肿瘤外科治疗的负预测因素（OR 0.62，p<0.001）（OR 0.81，p=0.03）。辅助 RT 与老年（HR 0.79，p<0.001）和非老年（HR 0.77，p<0.001）女性的死亡风险降低相关。
年龄超过 80 岁的子宫内膜癌患者的肿瘤外科治疗率与年轻女性相似，但接受辅助 RT 的可能性明显较低，这对她们的生存产生了负面影响。
