Stokes William A, Jones Bernard L, Schefter Tracey E, Fisher Christine M
Department of Radiation Oncology, University of Colorado Denver, Aurora, CO.
Department of Radiation Oncology, University of Colorado Denver, Aurora, CO.
Brachytherapy. 2018 Jan-Feb;17(1):194-200. doi: 10.1016/j.brachy.2017.09.011.
In the postoperative management of uterine carcinosarcoma (UCS), the roles of individual radiotherapy (RT) modalities, chiefly external-beam radiotherapy (EBRT) and brachytherapy (BT), remain undefined. We analyzed the survival impact of EBRT and BT using the National Cancer Database.
We abstracted women diagnosed with UCS from 2004 to 2012 who received hysterectomy and had complete RT information. Cox multivariate analysis and propensity-score matched analyses were used to compare survival among radiotherapeutic approaches.
We identified 1229 women receiving no radiotherapy, 472 receiving EBRT alone, 331 receiving BT alone, and 271 receiving EBRT+BT. On multivariate analysis of the entire analytic cohort, survival was significantly improved among patients receiving EBRT+BT combination (hazard ratio [HR] 0.72, 95% confidence interval [CI] = 0.58-0.89, p < 0.01), but not among those receiving EBRT alone (HR 0.93, 95% CI = 0.79-1.10, p = 0.41) or BT alone (HR 0.84, 95% CI = 0.68-1.03, p = 0.09). These results were confirmed on propensity-score matches for EBRT vs. no RT (HR 0.89, 95% CI = 0.73-1.07, p = 0.34), BT vs. no RT (HR 0.80, 95% CI = 0.63-1.03, p = 0.09), and EBRT+BT vs. no RT (HR 0.74, 95% CI = 0.58-0.96, p = 0.02).
EBRT+BT combination is associated with an overall survival advantage in UCS and warrants consideration in the adjuvant management of this disease.
在子宫癌肉瘤（UCS）的术后管理中，个体放疗（RT）方式的作用，主要是外照射放疗（EBRT）和近距离放疗（BT），仍不明确。我们使用国家癌症数据库分析了EBRT和BT对生存的影响。
我们提取了2004年至2012年期间被诊断为UCS、接受子宫切除术且有完整放疗信息的女性的数据。采用Cox多变量分析和倾向评分匹配分析来比较不同放疗方法的生存率。
我们确定了1229名未接受放疗的女性、472名单独接受EBRT的女性、331名单独接受BT的女性以及271名接受EBRT+BT的女性。在对整个分析队列进行多变量分析时，接受EBRT+BT联合治疗的患者生存率显著提高（风险比[HR]0.72，95%置信区间[CI]=0.58 - 0.89，p<0.01），但单独接受EBRT的患者（HR 0.93，95%CI = 0.79 - 1.10，p = 0.41）或单独接受BT的患者（HR 0.84，95%CI = 0.68 - 1.03，p = 0.09）生存率未显著提高。这些结果在EBRT与未放疗、BT与未放疗以及EBRT+BT与未放疗的倾向评分匹配分析中得到证实（EBRT与未放疗：HR 0.89，95%CI = 0.73 - 1.07，p = 0.34；BT与未放疗：HR 0.80，95%CI = 0.63 - 1.03，p = 0.09；EBRT+BT与未放疗：HR 0.74，95%CI = 0.58 - 0.96，p = 0.02）。
EBRT+BT联合治疗与UCS患者的总生存优势相关，在该疾病的辅助治疗中值得考虑。
