Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC; National Yang-Ming University, Taipei, Taiwan, ROC.
Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC.
Taiwan J Obstet Gynecol. 2019 Sep;58(5):604-609. doi: 10.1016/j.tjog.2019.07.005.
Postoperative radiotherapy for early endometrial cancer has been investigated in several randomized trials. These trials demonstrate that it reduces loco-regional recurrence, but has no impact on overall survival. The aims of this study were to better understand the role of adjuvant radiotherapy and determine predictors for loco-regional recurrence or development of distant metastasis.
A retrospective medical records review was performed on patients with surgical stage I endometrial cancer treated at Taipei Veterans General Hospital between 2006 and 2013. Multivariable analysis was conducted using Cox regression for prognostic predictors.
A total of 337 patients were identified. The estimated five-year overall survival and loco-regional recurrence-free survival were 96.3% and 97.9% in the non-radiotherapy group, and 91.6% and 97.1% in the radiotherapy group (p = 0.06 overall survival, p = 0.956 loco-regional recurrence-free survival). Multivariable analysis revealed that elevated preoperative serum Cancer Antigen 125 (CA-125) level (hazard ratio (HR) = 2.54), age older than 60 years old (HR = 3.34), and depth of myometrial invasion > 50% (HR = 3.37) were significant factors in overall survival. Elevated preoperative CA-125 level (HR = 5.37), age older than 60 years (HR = 6.57), positive lymphovascular space invasion (HR = 50.20), and adjuvant radiotherapy (HR = 0.05) were independent predictors of loco-regional recurrence-free survival. For distant metastasis, deep myometrial invasion was a significant risk factor.
Postoperative radiotherapy delivery is an independent predictor for loco-regional recurrence-free survival but has no impact on overall survival in this population. Preoperative CA-125 level is a risk factor for loco-regional recurrence, and deep myometrial invasion was correlated with distant metastasis.
早期子宫内膜癌的术后放疗已在几项随机试验中进行了研究。这些试验表明，它降低了局部区域复发率，但对总生存率没有影响。本研究的目的是更好地了解辅助放疗的作用，并确定局部区域复发或远处转移发展的预测因素。
对 2006 年至 2013 年在台北荣民总医院接受手术治疗的 I 期子宫内膜癌患者进行了回顾性病历回顾。使用 Cox 回归进行多变量分析，以确定预后预测因素。
共确定了 337 例患者。未接受放疗组的 5 年总生存率和局部区域无复发生存率分别为 96.3%和 97.9%，放疗组分别为 91.6%和 97.1%（p=0.06 总生存率，p=0.956 局部区域无复发生存率）。多变量分析显示，术前血清癌抗原 125（CA-125）水平升高（危险比（HR）=2.54）、年龄大于 60 岁（HR=3.34）和肌层浸润深度大于 50%（HR=3.37）是总生存率的显著因素。术前 CA-125 水平升高（HR=5.37）、年龄大于 60 岁（HR=6.57）、阳性淋巴管血管间隙浸润（HR=50.20）和辅助放疗（HR=0.05）是局部区域无复发生存的独立预测因素。对于远处转移，深肌层浸润是一个显著的危险因素。
在该人群中，术后放疗是局部区域无复发生存的独立预测因素，但对总生存率没有影响。术前 CA-125 水平是局部区域复发的危险因素，深肌层浸润与远处转移相关。
