Heumann T R, Diaz R, Liu Y, Hanley K, Bang S, Horowitz I R, Khanna N, Shelton J W
Eur J Gynaecol Oncol. 2017;38(3):404-412.
Because of rarity, consensus on adjuvant therapies for Type II endometrial cancers (BC) remains undefined. Reporting their institutional outcomes, the present authors assessed the impact of adjuvant therapies on recurrence and overall survival in women with 2009 FIGO Stage I-III Type II BC.
The authors identified 108 women, treated with definitive surgery between 2000-2013, with pathologically-confirmed Type II EC (non-endometrioid [NEM, n=801 and high grade endometrioid [G3EEC, n=28]) Cox proportional hazard models were used to assess the effect of prognostic variables on disease-free (DFS) and overall survival (OS). Kaplan-Meier method was used to assess survival.
Of the 108 women, 83 (77%) were African American (AA). Fifty-nine (55%), 12 (11%), and 37 (34%) were Stage I, II, and III, respectively. Ninety-seven patients received adjuvant therapy: 52 (radiation only), four (chemotherapy only), and 40 (combined). During follow-up (median 41 months), 44 patients (41%) recurred. Five-year DFS was 53% overall (48% [NEM], 80% [G3EEC]). Five-year OS was 75% overall (68% [NEM], 95% [G3EEC]). On multivariate analysis, lower stage and adjuvant radiation improved DFS. Higher stage, NEM, and increasing age were poor prognostic indicators of OS.
Representing a large single institutional cohort for Type II BC, the present study's observed sur- vival rates are consistent with previous studies, despite the relatively high frequency of carcinosarcoma and Stage III/nodal disease. The protective effect on recurrence was not lost when radiation was delayed for chemotherapy. The present results support a multimodal adjuvant approach for treating all stages of invasive NEM EC.
由于II型子宫内膜癌（BC）较为罕见，对于其辅助治疗的共识仍不明确。本研究作者报告了他们所在机构的治疗结果，评估了辅助治疗对2009年国际妇产科联盟（FIGO）I - III期II型BC女性患者复发和总生存期的影响。
作者确定了108例在2000 - 2013年间接受根治性手术且病理确诊为II型子宫内膜癌（EC）的女性患者（非子宫内膜样癌[NEM，n = 80]和高级别子宫内膜样癌[G3EEC，n = 28]）。采用Cox比例风险模型评估预后变量对无病生存期（DFS）和总生存期（OS）的影响。使用Kaplan - Meier方法评估生存率。
108例女性患者中，83例（77%）为非裔美国人（AA）。分别有59例（55%）、12例（11%）和37例（34%）处于I期、II期和III期。97例患者接受了辅助治疗：52例（仅放疗）、4例（仅化疗）和40例（放化疗联合）。在随访期间（中位时间41个月），44例患者（占41%）复发。5年DFS总体为53%（NEM为48%，G3EEC为80%）。5年OS总体为75%（NEM为68%，G3EEC为95%）。多因素分析显示，较低分期和辅助放疗可改善DFS。较高分期、NEM以及年龄增加是OS的不良预后指标。
本研究代表了一个大型的II型BC单机构队列，尽管癌肉瘤和III期/淋巴结疾病的发生率相对较高，但观察到的生存率与先前研究一致。当放疗因化疗而延迟时，对复发的保护作用并未丧失。本研究结果支持采用多模式辅助方法治疗所有分期的浸润性NEM EC。
