Division of Gynecologic Oncology; Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States of America.
Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States of America.
Gynecol Oncol. 2021 Feb;160(2):405-412. doi: 10.1016/j.ygyno.2020.11.012. Epub 2020 Nov 19.
To evaluate overall survival (OS) in women with advanced endometrial cancer (EC) following chemotherapy alone (CT), neoadjuvant chemotherapy and interval debulking surgery (NACT + IDS) or primary cytoreductive surgery and chemotherapy (PCS + CT).
The National Cancer Database (NCDB) was queried for patients with stage III/IV EC from 2004 to 2015. Univariable and multivariable Cox proportional hazards analyses assessed the impact of treatment modality upon OS.
Of 48,179 women identified, 5531 received CT (11.5%), 2614 NACT + IDS (5.4%) and 40,034 PCS + CT (83.1%). Median OS was 11.1 months for CT, 25.1 months for NACT + IDS and 60.9 months for PCS + CT (p < 0.001). On multivariate analysis, NACT + IDS (HR 0.44 (0.40, 0.49); p < 0.001) and PCS + CT (HR 0.32 (0.30, 0.35); p < 0.001) were associated with improved OS vs. CT alone. Age, African American race, income, higher Charlson comorbidity index and grade were predictors of worse OS (p < 0.001). On subgroup analysis by stage (III/IV) and histology (Type I/II), PCS + CT improved OS for all patients, compared to NACT + IDS (p < 0.001) and CT (p < 0.001). NACT + IDS was associated with improved OS vs. CT in stage III type I (HR 0.50; 95% CI 0.38, 0.67; p < 0.001), stage IV type I (HR 0.43; 95% CI 0.35, 0.52; p < 0.001), and stage IV type II EC (HR 0.43; 95% CI 0.36, 0.51; p < 0.001), but not stage III type II EC (HR 0.76; 95% CI 0.56, 1.03; p = 0.08).
In women with advanced EC, PCS + CT is associated with improved OS compared to NACT + IDS or CT alone, regardless of stage or histology. Additionally, NACT + IDS is associated with superior OS in stage III type I and all stage IV EC compared to CT alone. Where feasible, surgery should be incorporated into treatment planning in women with advanced EC.
评估单独化疗（CT）、新辅助化疗和间隔减瘤手术（NACT+IDS）或原发性细胞减灭术和化疗（PCS+CT）后晚期子宫内膜癌（EC）女性的总生存期（OS）。
从 2004 年到 2015 年，国家癌症数据库（NCDB）对 III/IV 期 EC 患者进行了查询。单变量和多变量 Cox 比例风险分析评估了治疗方式对 OS 的影响。
在 48179 名女性中，5531 名接受 CT（11.5%），2614 名接受 NACT+IDS（5.4%），40034 名接受 PCS+CT（83.1%）。CT 的中位 OS 为 11.1 个月，NACT+IDS 为 25.1 个月，PCS+CT 为 60.9 个月（p<0.001）。多变量分析显示，NACT+IDS（HR 0.44（0.40，0.49）；p<0.001）和 PCS+CT（HR 0.32（0.30，0.35）；p<0.001）与 OS 改善相关，优于 CT 单独治疗。年龄、非裔美国人种族、收入、较高的 Charlson 合并症指数和分级是 OS 较差的预测因素（p<0.001）。根据分期（III/IV）和组织学（I 型/II 型）的亚组分析，与 NACT+IDS（p<0.001）和 CT（p<0.001）相比，PCS+CT 改善了所有患者的 OS。与 CT 相比，NACT+IDS 在 III 期 I 型（HR 0.50；95%CI 0.38，0.67；p<0.001）、IV 期 I 型（HR 0.43；95%CI 0.35，0.52；p<0.001）和 IV 期 II 型 EC（HR 0.43；95%CI 0.36，0.51；p<0.001）中，OS 得到改善，但在 III 期 II 型 EC 中则不然（HR 0.76；95%CI 0.56，1.03；p=0.08）。
在晚期 EC 女性中，与 NACT+IDS 或 CT 单独治疗相比，PCS+CT 与 OS 改善相关，无论分期或组织学如何。此外，与 CT 单独治疗相比，NACT+IDS 在 III 期 I 型和所有 IV 期 EC 中具有更好的 OS。在可行的情况下，应将手术纳入晚期 EC 女性的治疗计划中。
