Beckmann Kerri, Selva-Nayagam Sudarshan, Olver Ian, Miller Caroline, Buckley Elizabeth S, Powell Kate, Buranyi-Trevarton Dianne, Gowda Raghu, Roder David, Oehler Martin K
Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia.
Medical Oncology, Royal Adelaide Hospital Cancer Centre, Adelaide, Australia.
Cancer Manag Res. 2021 Jun 10;13:4633-4645. doi: 10.2147/CMAR.S309551. eCollection 2021.
Uncertainties remain about the most effective treatment for uterine carcinosarcoma (UCS), a rare but aggressive uterine cancer, due to the limited scope for randomized trials. This study investigates whether nodal excision or adjuvant therapies after hysterectomy offer a survival benefit, using multi-institutional clinical registry data from South Australia.
Data for all consecutive cases of UCS from 1980 to 2019 were extracted from the Clinical Cancer Registry. Clinical and treatment-related factors associated with disease-specific mortality (DSM) and all-cause mortality (ACM) were determined using multivariable Cox proportional hazards regression, with subgroup analyses by stage.
Median follow-up for the 140 eligible cases was 21 months. 94% underwent hysterectomy, and 72% had an additional pelvic lymph node dissection (PLND). Furthermore, 16% received adjuvant chemotherapy; 11% adjuvant radiotherapy and 16% multimodal chemoradiotherapy, with an increase in the latter two modalities over time. DSM was reduced among those who underwent PLND (HR: 0.41; 95%CI: 0.23-0.74), adjuvant chemotherapy (HR: 0.39; 95%CI: 0.18-0.84) or multimodality treatment (HR: 0.11; 95%CI: 0.06-0.30) compared with hysterectomy alone for the whole cohort and for late stage disease (FIGO III/IV) but not for earlier stage disease, except for reduced DSM with multimodal therapy. Findings were similar for ACM.
Our findings indicate better survival among those who received PLND, chemotherapy and multimodal adjuvant therapy, with the latter applying to early and late stage disease. However, cautious interpretation is warranted, due to potential "indication bias" and limited power. Further research into effective treatment modalities, ideally using prospective study designs, is needed.
由于随机试验的范围有限，对于子宫癌肉瘤（UCS）这种罕见但侵袭性强的子宫癌，最有效的治疗方法仍存在不确定性。本研究利用南澳大利亚的多机构临床登记数据，调查子宫切除术后的淋巴结切除或辅助治疗是否能带来生存益处。
从临床癌症登记处提取1980年至2019年所有连续的UCS病例数据。使用多变量Cox比例风险回归确定与疾病特异性死亡率（DSM）和全因死亡率（ACM）相关的临床和治疗相关因素，并按阶段进行亚组分析。
140例符合条件的病例的中位随访时间为21个月。94%的患者接受了子宫切除术，72%的患者进行了额外的盆腔淋巴结清扫（PLND）。此外，16%的患者接受了辅助化疗；11%的患者接受了辅助放疗，16%的患者接受了多模式放化疗，后两种模式随时间增加。与单纯子宫切除术相比，对于整个队列和晚期疾病（国际妇产科联盟III/IV期），接受PLND（风险比：0.41；95%置信区间：0.23-0.74）、辅助化疗（风险比：0.39；95%置信区间：0.18-0.84）或多模式治疗（风险比：0.11；95%置信区间：0.06-0.30）的患者DSM降低，但早期疾病除外，多模式治疗可降低DSM。ACM的结果相似。
我们的研究结果表明，接受PLND、化疗和多模式辅助治疗的患者生存率更高，后者适用于早期和晚期疾病。然而，由于潜在的“指征偏倚”和研究效能有限，需要谨慎解读。需要对有效的治疗方式进行进一步研究，理想情况下采用前瞻性研究设计。
