宫颈癌盆腔放疗后异时性子宫恶性肿瘤的肿瘤特异性结局。
Tumor-specific outcome of metachronous uterine malignancy after pelvic irradiation for cervical cancer.
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan.
出版信息
Gynecol Oncol. 2018 Nov;151(2):250-256. doi: 10.1016/j.ygyno.2018.08.035. Epub 2018 Sep 6.
OBJECTIVE
To examine survival of women who develop metachronous uterine malignancy after definitive pelvic radiotherapy for cervical cancer.
METHODS
This retrospective observational study examined the Surveillance, Epidemiology, End Results Program between 1973 and 2013. Women with cervical cancer who received definitive radiotherapy without hysterectomy were examined for the diagnosis of metachronous uterine malignancy (n = 5277). Survival was compared between metachronous and non-metachronous uterine malignancies according to tumor factors.
RESULTS
The 10- and 20-year cumulative incidences of metachronous uterine malignancy were 0.6% and 1.2%, respectively. When compared to non-metachronous uterine malignancy, metachronous tumor were more likely to be non-endometrioid and advanced-stage (both, P < 0.001). As a whole cohort, metachronous uterine malignancy was significantly associated with decreased overall survival (OS) compared to non-metachronous tumors (hazard ratio [HR] 4.22, P < 0.001). OS was significantly worse in metachronous compared to non-metachronous malignancies, although the magnitude of statistical significance was greater for endometrioid tumors (HRs for endometrioid versus non-endometrioid: 6.17 versus 1.92). For grade 1-2 endometrial cancer, metachronous cases had significantly decreased OS compared to non-metachronous cases, a larger difference than that seen in higher grade tumors (HRs for grade 1-2 versus 3: 7.79 versus 2.15). Similarly, in early-stage endometrial cancer, metachronous cases had significantly decreased OS, with a greater HR compared to advanced-stage disease (HRs for stage I-II versus III-IV: 5.29 versus 2.29).
CONCLUSION
Radiotherapy-associated metachronous uterine malignancy after cervical cancer is rare but commonly presents with aggressive tumor characteristics. The impact on survival is considerably high when metachronous uterine malignancy is endometrioid, low-grade, and early-stage.
目的
研究宫颈癌根治性盆腔放疗后发生异时性子宫恶性肿瘤的女性的生存情况。
方法
本回顾性观察性研究调查了 1973 年至 2013 年间的监测、流行病学和最终结果计划。对未接受子宫切除术的宫颈癌患者进行了根治性放疗，以检查异时性子宫恶性肿瘤（n=5277）的诊断。根据肿瘤因素比较异时性和非异时性子宫恶性肿瘤的生存情况。
结果
10 年和 20 年的异时性子宫恶性肿瘤累积发生率分别为 0.6%和 1.2%。与非异时性子宫恶性肿瘤相比，异时性肿瘤更可能是非子宫内膜样和晚期（均 P<0.001）。作为一个整体队列，与非异时性肿瘤相比，异时性子宫恶性肿瘤的总生存（OS）明显降低（风险比[HR]4.22，P<0.001）。与非异时性恶性肿瘤相比，异时性肿瘤的 OS 明显较差，尽管子宫内膜样肿瘤的统计学显著性程度更大（子宫内膜样与非子宫内膜样肿瘤的 HRs：6.17 与 1.92）。对于 1-2 级子宫内膜癌，与非异时性病例相比，异时性病例的 OS 明显降低，与高级别肿瘤相比，差异更大（1-2 级与 3 级的 HRs：7.79 与 2.15）。同样，在早期子宫内膜癌中，异时性病例的 OS 明显降低，与晚期疾病相比，HR 更高（I-II 期与 III-IV 期的 HRs：5.29 与 2.29）。
结论
宫颈癌根治性盆腔放疗后发生的放疗相关性异时性子宫恶性肿瘤很少见，但常伴有侵袭性肿瘤特征。当异时性子宫恶性肿瘤为子宫内膜样、低级别和早期时，对生存的影响相当大。
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