Department of Obstetrics and Gynecology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo.
Department of Obstetrics and Gynecology, Oji General Hospital, Tomakomai, Hokkaido, Japan.
Jpn J Clin Oncol. 2020 Aug 4;50(8):882-888. doi: 10.1093/jjco/hyaa047.
This study compared the survival outcomes and the incidence of chemotherapy-related adverse events in endometrial cancer patients who received four and six cycles of adjuvant chemotherapy to examine the optimal number of adjuvant chemotherapy cycles.
A total of 112 patients with endometrial cancer with a high risk of recurrence were retrospectively enrolled; 46 patients received four cycles and 66 received six cycles of adjuvant chemotherapy. Between-group differences of overall survival, disease-free survival, hematological and non-hematological toxicities were analyzed. Baseline patient's background differences were assessed with inverse probability of treatment weighting using propensity score.
Overall and disease-free survivals between the two groups were not significantly different. Paclitaxel + carboplatin, every 3-4 weeks was the most frequently used chemotherapy regimen in both groups. Patients in the six-cycle chemotherapy group developed neutropenia G4 or febrile neutropenia more frequently than those in the four-cycle group; odds ratio (95% confidence interval) is 4.07 (1.51-10.96). Peripheral sensory neuropathy was the most frequently observed non-hematological toxicity; the incidence of peripheral sensory neuropathy was not significantly different between four- and six-cycle chemotherapy group, P = 0.832. The result was same in the subgroup analysis in patients who received TC regimen, P = 0.455.
This study implies a possible benefit of fewer cycles of adjuvant chemotherapy in endometrial cancer patients with a high risk of recurrence because of the lower incidence of hematological toxicities without impairing survival outcomes.
本研究比较了接受四周期和六周期辅助化疗的子宫内膜癌患者的生存结局和化疗相关不良事件发生率，以探讨辅助化疗的最佳周期数。
回顾性纳入 112 例有高复发风险的子宫内膜癌患者；46 例患者接受四周期辅助化疗，66 例患者接受六周期辅助化疗。分析两组患者的总生存期、无病生存期、血液学和非血液学毒性的差异。采用倾向性评分的逆概率治疗加权法评估两组间患者基线背景差异。
两组患者的总生存期和无病生存期无显著差异。紫杉醇+卡铂，每 3-4 周为两组最常用的化疗方案。六周期化疗组患者发生 4 级中性粒细胞减少或发热性中性粒细胞减少的频率高于四周期化疗组；比值比（95%置信区间）为 4.07（1.51-10.96）。周围感觉神经病变是最常见的非血液学毒性；四周期和六周期化疗组间周围感觉神经病变的发生率无显著差异，P=0.832。在接受 TC 方案的患者亚组分析中，结果相同，P=0.455。
本研究表明，对于高复发风险的子宫内膜癌患者，接受较少周期的辅助化疗可能具有获益，因为血液学毒性的发生率较低，而不影响生存结局。
