Department of Oncology, Queen's University, Kingston K7L 5P9, Canada.
Department of Radiation Oncology, London Regional Cancer Program, Western University, London N6A 5W9, Canada.
Gynecol Oncol. 2018 May;149(2):283-290. doi: 10.1016/j.ygyno.2018.03.002. Epub 2018 Mar 12.
As the optimal adjuvant management of stage IA serous or clear cell endometrial cancer is controversial, a multi-institutional review was conducted with the objective of evaluating the appropriateness of various strategies including observation.
Retrospective chart reviews for 414 consecutive patients who underwent hysterectomy for FIGO stage IA endometrial cancer with serous, clear cell or mixed histology between 2004 and 2015 were conducted in 6 North American centers. Time-to-event outcomes were analyzed by Kaplan-Meier estimates, log-rank test, univariable and multivariable cox proportional hazard regression models.
Post-operative management included observation (50%), chemotherapy and radiotherapy (RT) (27%), RT only (16%) and chemotherapy only (7%). The 178 RT patients received external beam (EBRT, 16%), vaginal vault brachytherapy (VVB, 56%) or both (28%). Among patients without any adjuvant treatment, 5-year local control (LC), disease free survival (DFS) and cancer-specific survival (CSS) were 82% (95% confidence interval: 74-88), 70% (62-78) and 90% (82-94), respectively. CSS in patients without adjuvant treatment was improved with adequate surgical staging (100% vs. 87% (77-92), log-rank p=0.022). Adjuvant VVB was associated with improved LC (5-year 96% (91-99) vs. 84% (76-89), log-rank p=0.007) and DFS (5-year 79% (66-88) vs. 71% (63-77), log-rank p=0.033). Adjuvant chemotherapy was associated with better LC (5-year 96% (90-98) vs. 84% (77-89), log-rank p=0.014) and DFS (5-year 84% (74-91) vs. 69% (61-76), log-rank p=0.009). On multivariable analysis, adjuvant chemotherapy and VVB were associated with improved LC while adjuvant chemotherapy and age were significant for DFS.
In stage IA serous or clear cell uterine cancer, adjuvant RT and chemotherapy were associated with better LC and DFS. Observation may be appropriate in patients who have had adequate surgical staging.
由于 IA 期浆液性或透明细胞子宫内膜癌的最佳辅助治疗存在争议，因此进行了多机构回顾性研究，目的是评估各种策略的适当性，包括观察。
对 2004 年至 2015 年间在 6 个北美中心接受 FIGO IA 期子宫内膜癌伴浆液性、透明细胞或混合组织学子宫切除术的 414 例连续患者进行回顾性图表审查。采用 Kaplan-Meier 估计、对数秩检验、单变量和多变量 Cox 比例风险回归模型分析生存时间。
术后管理包括观察（50%）、化疗和放疗（RT）（27%）、仅 RT（16%）和仅化疗（7%）。178 例接受 RT 的患者接受了外部束放疗（EBRT，16%）、阴道穹窿近距离放疗（VVB，56%）或两者（28%）。在没有任何辅助治疗的患者中，5 年局部控制（LC）、无病生存率（DFS）和癌症特异性生存率（CSS）分别为 82%（95%置信区间：74-88%）、70%（62-78%）和 90%（82-94%）。无辅助治疗患者的 CSS 随充分的手术分期而改善（100%比 87%（77-92），对数秩 p=0.022）。辅助性 VVB 与 LC 改善相关（5 年 96%（91-99%）比 84%（76-89%），对数秩 p=0.007）和 DFS（5 年 79%（66-88%）比 71%（63-77%），对数秩 p=0.033）。辅助化疗与更好的 LC（5 年 96%（90-98%）比 84%（77-89%），对数秩 p=0.014）和 DFS（5 年 84%（74-91%）比 69%（61-76%），对数秩 p=0.009）相关。多变量分析显示，辅助化疗和 VVB 与 LC 改善相关，而辅助化疗和年龄与 DFS 显著相关。
在 IA 期浆液性或透明细胞子宫癌中，辅助放疗和化疗与更好的 LC 和 DFS 相关。在充分手术分期的患者中，观察可能是合适的。
