Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan.
Clinical Trial Center, Chang Gung Memorial Hospital, Taiwan.
J Formos Med Assoc. 2021 Nov;120(11):1977-1987. doi: 10.1016/j.jfma.2021.04.016. Epub 2021 May 13.
To investigate the prognostic factors and impact of adjuvant treatment on uterine carcinosarcoma (UCS).
A retrospective review of UCS patients treated between 2005 and 2019 was conducted. International Federation of Gynecology and Obstetrics (FIGO) 2009 staging system was used. Multivariate stepwise Cox proportional hazard regression models were used to identify the independent predictors of overall survival (OS) and progression-free survival (PFS).
A total of 138 patients were eligible for descriptive analysis. Excluding 12 patients without surgery, 126 patients with adequate clinicopathologic data were included for prognostic analysis. The median follow-up for survivors was 51.8 months. 5-year OS and PFS rates for FIGO stage I, II, III, IV were 64.5% and 51.8%, 60.8% and 57.7%, 47.7% and 45.9%, 5.1% and 4.1%, respectively. By multivariate analysis, six models each for PFS and OS were formulated including highly correlated variables alternatively. Adjuvant chemoradiation was consistently selected as an independent prognostic factor for OS (hazard ratio [HR] 0.10-0.22, all p < 0.001) and PFS (HR 0.12-0.23, all p < 0.001), while adjuvant chemotherapy (HR 0.33-0.41), age≥58 years (HR 1.80-1.91), stage III/IV (HR 3.36-13.34), and adnexal metastasis (HR 2.06-5.02) in three to four of the six models for OS. Stratified analyses revealed that adjuvant chemoradiation significantly improved outcome compared with adjuvant chemotherapy for stage IA patients with lymphovascular space invasion and stage IB-IV, lymph node metastasis, and adnexal metastasis.
Adjuvant chemoradiation was confirmed as an independent good prognostic factor, while older age, stage III/IV, and adnexal metastasis were associated with poor outcome in UCS.
探讨子宫癌肉瘤（UCS）的预后因素和辅助治疗的影响。
对 2005 年至 2019 年间接受治疗的 UCS 患者进行回顾性分析。采用国际妇产科联合会（FIGO）2009 分期系统。采用多变量逐步 Cox 比例风险回归模型确定总生存（OS）和无进展生存（PFS）的独立预测因素。
共有 138 例患者符合描述性分析标准。排除 12 例未手术患者，纳入 126 例临床病理资料完整的患者进行预后分析。幸存者的中位随访时间为 51.8 个月。FIGO Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期的 5 年 OS 和 PFS 率分别为 64.5%和 51.8%、60.8%和 57.7%、47.7%和 45.9%、5.1%和 4.1%。多变量分析中，每个模型均包括高度相关的变量，共构建了 6 个 PFS 和 OS 模型。辅助放化疗是 OS（风险比[HR]0.10-0.22，均 P<0.001）和 PFS（HR0.12-0.23，均 P<0.001）的独立预后因素，而辅助化疗（HR0.33-0.41）、年龄≥58 岁（HR1.80-1.91）、Ⅲ/Ⅳ期（HR3.36-13.34）和附件转移（HR2.06-5.02）在 6 个 OS 模型中的 3 至 4 个模型中被选择。分层分析显示，对于有淋巴血管间隙浸润和ⅠB-IV 期、淋巴结转移和附件转移的ⅠA 期患者，辅助放化疗显著改善了结局，优于辅助化疗。
辅助放化疗被证实为独立的良好预后因素，而年龄较大、Ⅲ/Ⅳ期和附件转移与 UCS 的不良预后相关。
