McEachron Jennifer, Marshall Lila, Zhou Nancy, Tran Van, Kanis Margaux J, Gorelick Constantine, Lee Yi-Chun
Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
Division of Gynecologic Oncology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY 11203, USA.
Cancers (Basel). 2021 Apr 23;13(9):2052. doi: 10.3390/cancers13092052.
We seek to evaluate the difference in recurrence patterns and survival among stage IIIC high-grade endometrial cancer treated with surgery followed by adjuvant chemotherapy alone, radiation therapy alone, or both (chemoradiation).
A multicenter retrospective analysis of surgically staged IIIC HGEC receiving adjuvant therapy was conducted. HGEC was defined as grade 3 endometrioid adenocarcinoma, serous, clear cell and carcinosarcoma. Differences in the frequency of recurrence sites and treatment delays were identified using Pearson's χ test. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier estimates.
A total of 155 patients were evaluable: 41.9% carcinosarcoma, 36.8% serous, 17.4% grade 3 and 3.9% clear cell. Of these, 67.1% received chemoradiation, 25.8% received chemotherapy and 7.1% received radiation therapy. There was no difference in the frequency of treatment delays between regimens ( = 0.571). There was a trend towards greater retroperitoneal recurrence with chemotherapy (25.9%) versus chemoradiation (8.4%) and radiation therapy (7.7%) ( = 0.252). Grade 3 tumors had improved progression-free and overall survival (26 and 42 months, respectively) versus serous (17 and 30 months, respectively), carcinosarcoma (14 and 24 months, respectively) and clear cell (24 and 30 months respectively) ( = 0.002, < 0.001). Overall, chemoradiation was superior to chemotherapy and radiation therapy in PFS ( < 0.001) and OS ( < 0.001). Upon multivariate analysis, only histology and receipt of chemoradiation were independent predictors of survival.
The majority of stage IIIC high-grade endometrial carcinomas recurred. Chemoradiation was associated with improved survival and less retroperitoneal recurrence. Grade 3 tumors demonstrated improved survival versus other histologies regardless of adjuvant treatment modality.
我们旨在评估接受手术加单纯辅助化疗、单纯放疗或两者联合（放化疗）治疗的IIIC期高级别子宫内膜癌患者的复发模式和生存率差异。
对接受辅助治疗的手术分期IIIC期高级别子宫内膜癌患者进行多中心回顾性分析。高级别子宫内膜癌定义为3级子宫内膜样腺癌、浆液性癌、透明细胞癌和癌肉瘤。使用Pearson卡方检验确定复发部位频率和治疗延迟的差异。采用Kaplan-Meier估计法计算无进展生存期（PFS）和总生存期（OS）。
共有155例患者可评估：41.9%为癌肉瘤，36.8%为浆液性癌，17.4%为3级，3.9%为透明细胞癌。其中，67.1%接受放化疗，25.8%接受化疗，7.1%接受放疗。各治疗方案之间的治疗延迟频率无差异（P = 0.571）。化疗组腹膜后复发趋势高于放化疗组（8.4%）和放疗组（7.7%）（25.9%）（P = 0.252）。3级肿瘤的无进展生存期和总生存期（分别为26个月和42个月）优于浆液性癌（分别为17个月和30个月）、癌肉瘤（分别为14个月和24个月）和透明细胞癌（分别为24个月和30个月）（P = 0.002，P < 0.001）。总体而言，放化疗在PFS（P < 0.001）和OS（P < 0.001）方面优于化疗和放疗。多因素分析显示，只有组织学类型和放化疗是生存的独立预测因素。
大多数IIIC期高级别子宫内膜癌会复发。放化疗与生存率提高和腹膜后复发减少相关。无论辅助治疗方式如何，3级肿瘤的生存率均优于其他组织学类型。
