Department of Radiation Oncology, University of Louisville, Louisville, Kentucky, USA.
Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, Kentucky, USA.
Int J Gynecol Cancer. 2021 May;31(5):694-701. doi: 10.1136/ijgc-2021-002380. Epub 2021 Mar 19.
The optimal treatment of patients with FIGO stage IB grade 3 endometrial endometrioid adenocarcinoma remains unknown.
To compare overall survival following treatment with a hysterectomy and adjuvant radiotherapy with or without chemotherapy in this group of patients.
Patients diagnosed between January 2004 and January 2016 with FIGO stage IB grade 3 endometrial endometrioid adenocarcinoma treated with hysterectomy and postoperative radiotherapy with or without adjuvant concurrent chemotherapy were identified in the National Cancer Database. Overall survival was assessed with Kaplan-Meier curves. A Cox model was constructed to evaluate survival after controlling for confounding variables. A logistic regression model was used to reveal predictors of chemotherapy use.
A total of 2173 patients were included. The receipt of chemotherapy was associated with an increased 5-year overall survival from 67.6% to 75.6% (p=0.0313). This association trended toward statistical significance on multivariate analysis (adjusted HR (aHR) 0.80; 95% CI 0.63 to 1.01; p=0.0653). Other factors associated with improved survival were undergoing a lymphadenectomy, absence of lymphovascular space invasion, younger age, smaller tumor size, non-black race, and absence of comorbidities. Patients who underwent brachytherapy, had lymphovascular space invasion, were younger, were diagnosed in the more recent years, and were treated in higher volume centers were more likely to receive adjuvant chemotherapy.
Adjuvant chemotherapy and radiation therapy were associated with an increase in survival in patients with FIGO stage IB grade 3 endometrial endometrioid adenocarcinoma compared with those treated with adjuvant radiotherapy alone.
FIGO 分期 IB 级 3 期子宫内膜子宫内膜样腺癌患者的最佳治疗方法仍不清楚。
比较此类患者接受子宫切除术和辅助放疗联合或不联合化疗后的总生存率。
在国家癌症数据库中，确定了 2004 年 1 月至 2016 年 1 月期间诊断为 FIGO 分期 IB 级 3 期子宫内膜子宫内膜样腺癌、接受子宫切除术和术后放疗联合或不联合辅助同期化疗的患者。使用 Kaplan-Meier 曲线评估总生存率。构建 Cox 模型来评估控制混杂因素后的生存情况。使用逻辑回归模型揭示化疗使用的预测因素。
共纳入 2173 例患者。接受化疗与 5 年总生存率从 67.6%增加到 75.6%相关（p=0.0313）。多变量分析显示这种相关性具有统计学意义（调整后的 HR（aHR）0.80；95%CI 0.63 至 1.01；p=0.0653）。其他与生存改善相关的因素包括进行淋巴结切除术、无淋巴血管空间侵犯、年龄较小、肿瘤较小、非黑人种族和无合并症。接受近距离放疗、有淋巴血管空间侵犯、年龄较小、诊断时间较晚、在高容量中心治疗的患者更有可能接受辅助化疗。
与单独接受辅助放疗相比，FIGO 分期 IB 级 3 期子宫内膜子宫内膜样腺癌患者接受辅助化疗和放疗可提高生存率。
