Columbia University Vagelos College of Physicians and Surgeons, USA.
Columbia University Vagelos College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; NewYork-Presbyterian Hospital, USA.
Gynecol Oncol. 2020 Dec;159(3):737-743. doi: 10.1016/j.ygyno.2020.09.033. Epub 2020 Sep 30.
The optimal adjuvant therapy for stage III endometrial cancer is unknown. Studies have suggested that combination therapy with chemotherapy and radiation is associated with improved survival. We examined early and late-term toxicities associated with chemotherapy (CT), external beam radiotherapy (RT), or combination chemoradiotherapy for stage III uterine cancer.
The SEER-Medicare database was used to identify women age ≥ 65 years with stage III uterine cancer who received adjuvant CT, RT, or chemoradiotherapy from 2000 to 2015. The associations between therapy and early and late-term toxicities identified with billing claims, hospitalizations and emergency department visits were examined using multivariable regression models.
A total of 2185 patients were identified including 574 (26.3%) who received CT, 636 (29.1%) who received RT, and 975 (44.6%) who received chemoradiotherapy. The proportion of patients receiving chemoradiotherapy or CT increased over time. During the first 6 and 12 months of adjuvant therapy, RT was associated with a lower risk of early-term toxicity compared to chemoradiotherapy (aRR = 0.59, 95%CI 0.49-0.70 and aRR = 0.76, 95%CI 0.67-0.86, respectively) while CT shared a similar risk of early toxicities as chemoradiotherapy. CT and RT shared a similar risk of late-term toxicities compared to chemoradiotherapy. CT and RT alone were associated with a higher hazard for overall mortality than chemoradiotherapy (aHR = 1.27, 95% CI 1.10-1.47 and aHR = 1.25, 95% CI 1.08-1.44, respectively).
Chemoradiotherapy is associated with lower mortality compared to single modality therapy and has a similar risk of early and late term toxicities compared to CT, though higher risk of early toxicities compared to RT.
对于 III 期子宫内膜癌，最佳辅助治疗方法尚不清楚。有研究表明，化疗联合放疗可改善生存。我们检查了 III 期子宫癌患者接受化疗（CT）、外照射放疗（RT）或放化疗联合治疗的早期和晚期毒性。
使用 SEER-Medicare 数据库，确定了 2000 年至 2015 年间接受辅助 CT、RT 或放化疗的年龄≥65 岁的 III 期子宫癌女性患者。使用多变量回归模型检查了与计费索赔、住院和急诊就诊相关的治疗与早期和晚期毒性之间的关联。
共纳入 2185 例患者，其中 574 例（26.3%）接受 CT 治疗，636 例（29.1%）接受 RT 治疗，975 例（44.6%）接受放化疗。接受放化疗或 CT 的患者比例随时间推移而增加。在辅助治疗的前 6 个月和 12 个月期间，与放化疗相比，RT 发生早期毒性的风险较低（ARR=0.59，95%CI 0.49-0.70 和 aRR=0.76，95%CI 0.67-0.86），而 CT 与放化疗发生早期毒性的风险相似。与放化疗相比，CT 和 RT 发生晚期毒性的风险相似。与放化疗相比，CT 和 RT 单独治疗的总死亡率较高（aHR=1.27，95%CI 1.10-1.47 和 aHR=1.25，95%CI 1.08-1.44）。
与单模态治疗相比，放化疗联合治疗与较低的死亡率相关，与 CT 相比，其早期和晚期毒性风险相似，但与 RT 相比，早期毒性风险更高。
