Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA.
Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
J Gynecol Oncol. 2020 Nov;31(6):e84. doi: 10.3802/jgo.2020.31.e84.
The management of stage II endometrial cancer (EC) is challenging due to the wide variation in surgical practice and adjuvant treatment recommendations. We sought to describe the treatment patterns for patients with stage II EC and to evaluate the association between surgical management and adjuvant therapy on survival outcomes in a large cohort of patients with stage II EC.
Using data from the National Cancer Database, we identified 9,690 women with stage II EC. We used logistic regression to identify association of sociodemographic and tumor characteristics with surgery type and receipt of adjuvant therapy. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between adjuvant therapy, hysterectomy type, and overall survival.
Almost 11% of the cohort underwent radical hysterectomy; however, there was no difference in survival between surgical types even when adjusted for adjuvant therapy (HR=0.94; 95% CI=0.82-1.07). Compared to no adjuvant treatment, radiation only (HR=0.66; 95% CI=0.61-0.73) and combination radiation and chemotherapy (HR=0.53; 95% CI=0.45-0.62) were associated with lower risk of death. There was no survival benefit of chemotherapy alone even when separated by histologic subtype (HR range, 0.55-1.46).
Women with stage II EC do not appear to benefit from routine radical hysterectomy though all patients appear to benefit from receipt of radiation therapy (RT), regardless of modality. Additionally, there may be an added survival benefit with the combination of computed tomography and RT in patients with non-endometrioid, high-risk histologies.
由于手术实践和辅助治疗建议存在广泛差异，因此，Ⅱ期子宫内膜癌（EC）的治疗颇具挑战性。我们旨在描述Ⅱ期 EC 患者的治疗模式，并在Ⅱ期 EC 大患者队列中评估手术管理与辅助治疗对生存结果的关联。
我们使用国家癌症数据库的数据，确定了 9690 名患有Ⅱ期 EC 的女性。我们使用逻辑回归来确定社会人口统计学和肿瘤特征与手术类型和辅助治疗的相关性。我们使用 Cox 比例风险回归模型来估计辅助治疗、子宫切除术类型和总生存率之间的关联的风险比（HR）和 95％置信区间（CI）。
该队列中有近 11％的患者接受了根治性子宫切除术；但是，即使调整了辅助治疗，手术类型之间的生存也没有差异（HR=0.94；95％CI=0.82-1.07）。与未接受辅助治疗相比，仅接受放疗（HR=0.66；95％CI=0.61-0.73）和联合放疗和化疗（HR=0.53；95％CI=0.45-0.62）与死亡风险降低相关。即使按组织学亚型分开，单独化疗也没有生存获益（HR 范围，0.55-1.46）。
尽管所有患者似乎都受益于放射治疗（RT），但接受常规根治性子宫切除术的Ⅱ期 EC 患者似乎并未从中受益。此外，在非子宫内膜样，高危组织学的患者中，联合 CT 和 RT 可能会有额外的生存获益。
