辅助放疗的生存获益：低分期侵袭性卵巢黏液性癌的分析

Survival Benefit of Adjuvant Radiotherapy: An Analysis of Low-Stage Invasive Ovarian Mucinous Carcinomas.

作者信息

Kumar Aalok, Le Nhu, Gilks C Blake, Santos Jennifer L, Wong Frances, Swenerton Kenneth, Hoskins Paul J, McAlpine Jessica N, Tinker Anna V

机构信息

*BC Cancer Agency, Surrey Clinic, Surrey; and †Cancer Control, British Columbia Cancer Research Centre; ‡Cheryl Brown Ovarian Cancer Outcomes Unit, OvCaRe; §Vancouver General Hospital and University of British Columbia; and ∥BC Cancer Agency, Vancouver Clinic, Vancouver, British Columbia, Canada.

出版信息

Int J Gynecol Cancer. 2017 Nov;27(9):1819-1825. doi: 10.1097/IGC.0000000000001124.

DOI:10.1097/IGC.0000000000001124

PMID:28930809

Abstract

OBJECTIVE

Our aim was to evaluate the population-based outcomes of stages I and II invasive ovarian mucinous carcinomas (MCs) treated with adjuvant platinum-based chemotherapy and abdominopelvic radiotherapy (XRT).

METHODS

International Federation of Gynecology and Obstetrics stage I/II MC cases referred to the British Columbia Cancer Agency between 1984 and 2014 were reviewed. Chemotherapy (minimum of 3 cycles) and XRT were the institutional policy for stages IA/B (grade 2/3) and IC/II (any grade). Physician patterns of practice determined XRT use in eligible patients, allowing for the comparison of outcomes based on receipt of XRT treatment on disease-free survival (DFS) and overall survival (OS).

RESULTS

We identified 129 patients. Univariate analyses on substages IA, IC no rupture, IC with intraoperative rupture, and IC with preoperative rupture demonstrated 10-year DFS rates of 67%, 67%, 67%, and 27% (P = 0.004), respectively, and OS rates of 72%, 72%, 67%, and 38% (P = 0.01), respectively. For all patients, adjuvant XRT demonstrated improved 10-year DFS (78% vs 36%, P = 0.05) and OS (83% vs 36%, P = 0.02). Subgroup analysis did not detect a benefit of adjuvant therapy for stage IA grade 1/2. Multivariate analysis confirmed the benefit of XRT on DFS (hazard ratio, 0.14; 95% confidence interval, 0.02-0.98; P = 0.047) and a trend to improved OS (hazard ratio, 0.12; 95% confidence interval, 0.009-1.64; P = 0.11), whereas decision tree analysis demonstrated a reduced rate of relapse (33% vs 77%) and death (20% vs 46%) with the use of XRT, exclusive of patients with preoperative rupture.

CONCLUSIONS

This population-based retrospective study is the first to demonstrate that the use of adjuvant abdominopelvic XRT after chemotherapy can improve survival in patients diagnosed as having stage I/II MC. Patients with stage IA grade 1 and grade 2 MC can have adjuvant therapy omitted.

摘要

目的

我们的目的是评估接受铂类辅助化疗和腹盆腔放疗（XRT）的Ⅰ期和Ⅱ期浸润性卵巢黏液性癌（MC）的基于人群的治疗结果。

方法

回顾了1984年至2014年间转诊至不列颠哥伦比亚癌症机构的国际妇产科联盟Ⅰ/Ⅱ期MC病例。化疗（至少3个周期）和XRT是IA/B期（2/3级）和IC/II期（任何级别）的机构治疗策略。医生的治疗模式决定了符合条件的患者是否接受XRT治疗，从而能够比较接受XRT治疗与未接受XRT治疗的无病生存期（DFS）和总生存期（OS）的结果。

结果

我们确定了129例患者。对IA期、IC期无破裂、IC期术中破裂和IC期术前破裂亚组的单因素分析显示，10年DFS率分别为67%、67%、67%和27%（P = 0.004），OS率分别为72%、72%、67%和38%（P = 0.01）。对于所有患者，辅助XRT显示10年DFS（78%对36%，P = 0.05）和OS（83%对36%，P = 0.02）有所改善。亚组分析未发现IA期1/2级患者辅助治疗的益处。多因素分析证实XRT对DFS有益（风险比，0.14；95%置信区间，0.02 - 0.98；P = 0.047），OS有改善趋势（风险比，0.12；95%置信区间，0.009 - 1.64；P = 0.11），而决策树分析显示使用XRT（不包括术前破裂患者）可降低复发率（33%对77%）和死亡率（20%对46%）。