AlHilli Mariam, Elson Paul, Rybicki Lisa, Amarnath Sudha, Yang Bin, Michener Chad M, Rose Peter G
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Cleveland Clinic, Cleveland, Ohio, USA
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio, USA.
Int J Gynecol Cancer. 2019 Sep;29(7):1126-1133. doi: 10.1136/ijgc-2019-000465. Epub 2019 Aug 17.
Undifferentiated endometrioid endometrial carcinoma of the uterus is a rare, highly aggressive, and under-recognized subtype of endometrial cancer.
This study evaluates survival, prognostic factors for survival, and treatment outcomes associated with undifferentiated endometrial cancer.
The National Cancer Database was queried to identify patients with undifferentiated endometrial cancer who underwent definitive primary surgical treatment. Patients with all other histologic subtypes or incomplete treatment data were excluded. Univariable and multivariable Cox proportional hazards analyses were used to determine independent prognostic factors for survival. Points for each prognostic factor were assigned from regression coefficients in the final multivariable model and summed for a total score. Recursive partitioning analysis was used to determine cut-offs in the score to identify unique prognostic groups.
Among 349 404 women diagnosed with endometrial cancer from 2004 to 2013, 3994 (1.1%) met the criteria for diagnosis of undifferentiated endometrial cancer and 3486 had survival data. Median age at diagnosis was 65 years (interquartile range (IQR) 57-74) and 58% of patients had early stage disease. Median interval from diagnosis to surgery was 3.7 weeks (IQR 2.0-5.7). Five year overall survival was 57% (standard error (SE) 1%). Stage was the strongest predictor of survival, with a 15-20% decrement in 5 year survival for each advance in stage. Stage, age, race, and presence of comorbidities were independent predictors of survival and were used to categorize patients into five prognostic groups. Adjuvant therapy was associated with improved survival across most disease stages and prognostic groups. Multimodal adjuvant therapy was superior to unimodal treatment particularly in advanced stage unfavorable and very unfavorable groups.
In women with undifferentiated endometrial cancer, survival is primarily driven by stage. Despite the poor overall prognosis of undifferentiated endometrial cancer, multimodal adjuvant therapy is a key component of treatment.
子宫未分化子宫内膜样癌是一种罕见、侵袭性强且认识不足的子宫内膜癌亚型。
本研究评估未分化子宫内膜癌的生存率、生存预后因素及治疗结局。
查询国家癌症数据库，以识别接受确定性原发性手术治疗的未分化子宫内膜癌患者。排除所有其他组织学亚型或治疗数据不完整的患者。采用单变量和多变量Cox比例风险分析来确定生存的独立预后因素。根据最终多变量模型中的回归系数为每个预后因素赋值，并将其相加以获得总分。采用递归划分分析来确定分数的临界值，以识别独特的预后组。
在2004年至2013年诊断为子宫内膜癌的349404名女性中，3994名（1.1%）符合未分化子宫内膜癌的诊断标准，3486名有生存数据。诊断时的中位年龄为65岁（四分位间距（IQR）57 - 74岁），58%的患者为早期疾病。从诊断到手术的中位间隔时间为3.7周（IQR 2.0 - 5.7）。5年总生存率为57%（标准误（SE）1%）。分期是生存的最强预测因素，分期每进展一期，5年生存率下降15 - 20%。分期、年龄、种族和合并症的存在是生存的独立预测因素，并用于将患者分为五个预后组。辅助治疗与大多数疾病分期和预后组的生存率提高相关。多模式辅助治疗优于单模式治疗，尤其是在晚期不良和非常不良组中。
在未分化子宫内膜癌女性中，生存主要由分期决定。尽管未分化子宫内膜癌的总体预后较差，但多模式辅助治疗是治疗的关键组成部分。
