Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA.
Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
Gynecol Oncol. 2018 Oct;151(1):82-90. doi: 10.1016/j.ygyno.2018.08.028. Epub 2018 Aug 28.
We evaluated the utilization of vaginal brachytherapy (BT) and the resulting impact on survival in stage IA endometrial cancer of clear cell (CC), papillary serous (PS), and carcinosarcoma (CS) histology.
Patients with uterine cancer diagnosed from 2004 to 2015 were identified from the National Cancer Database. Patients underwent hysterectomy, showing FIGO stage IA disease with CC, PS, or CS histology. Logistic regression was used to evaluate predictors of BT utilization and to generate propensity scores. Survival was compared using log-rank test and Cox proportional hazards modeling, with propensity score adjustment.
We identified 5711 patients who underwent hysterectomy showing FIGO pT1a, N0 or NX endometrial cancer with CC, PS, or CS histology, of which 29.5% received BT. Multivariate predictors of increased receipt of BT were identified. With a median follow-up of 3.3 years, 3-year overall survival (OS) was 87% for those receiving BT versus 78% for those without (p < 0.001). A survival benefit to BT was maintained across histologies. Similar results were seen whether tumor was confined to endometrium or had <50% myometrial invasion. On multivariate analysis, receipt of BT was associated with increased survival (hazard ratio [HR] 0.75, 95% confidence interval 0.65-0.87, p < 0.001). The benefit of BT persisted after propensity score adjustment (HR 0.76, p < 0.001).
In this cohort of women with stage IA endometrial cancer of unfavorable histology, the use of BT was associated with improved survival. In this study, 29.5% of patients in our cohort received BT.
我们评估了阴道近距离放疗（BT）的应用及其对子宫内膜癌透明细胞（CC）、乳头状浆液性（PS）和癌肉瘤（CS）组织学分期 IA 患者生存的影响。
从国家癌症数据库中确定了 2004 年至 2015 年期间诊断为子宫癌的患者。这些患者接受了子宫切除术，FIGO 分期为 IA 期疾病，伴有 CC、PS 或 CS 组织学表现。采用 logistic 回归分析评估 BT 应用的预测因素，并生成倾向评分。采用对数秩检验和 Cox 比例风险模型比较生存情况，并进行倾向评分调整。
我们确定了 5711 例接受子宫切除术的患者，其FIGO pT1a、N0 或 NX 期伴有 CC、PS 或 CS 组织学的子宫内膜癌，其中 29.5%的患者接受了 BT。确定了增加 BT 接受率的多变量预测因素。中位随访 3.3 年后，接受 BT 的患者 3 年总生存率（OS）为 87%，未接受 BT 的患者为 78%（p<0.001）。BT 治疗的生存获益在所有组织学类型中均得以维持。无论肿瘤局限于子宫内膜还是浸润深度<50%，均观察到类似的结果。多变量分析显示，接受 BT 与生存率提高相关（风险比 [HR] 0.75，95%置信区间 0.65-0.87，p<0.001）。在倾向评分调整后，BT 的获益仍然存在（HR 0.76，p<0.001）。
在这组分期为 IA 期、组织学不良的子宫内膜癌患者中，BT 的应用与生存改善相关。在本研究中，我们队列中的 29.5%的患者接受了 BT。
