新辅助化疗治疗转移性子宫癌的应用及疗效。
Use and outcomes of neoadjuvant chemotherapy for metastatic uterine cancer.
机构信息
Columbia University Vagelos College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; NewYork-Presbyterian Hospital, USA.
Columbia University Vagelos College of Physicians and Surgeons, USA.
出版信息
Gynecol Oncol. 2021 Sep;162(3):599-605. doi: 10.1016/j.ygyno.2021.06.016. Epub 2021 Jun 20.
OBJECTIVE
Neoadjuvant chemotherapy (NACT) has emerged as an alternative to primary cytoreductive surgery (PCS) for stage IV uterine cancer. We examined utilization, perioperative outcomes and survival for NACT and PCS for stage IV uterine cancer.
METHODS
The Surveillance, Epidemiology, End Results-Medicare database was used to identify women with stage IV uterine cancer treated from 2000 to 2015. Women were classified as NACT or PCS. Interval cytoreductive surgery (after NACT) or chemotherapy (after PCS) were recorded. The extent of surgery and perioperative outcomes were estimated for the groups. Multivariable proportional hazards models and Kaplan-Meier analyses were used to examine survival.
RESULTS
Among 3037 women, 1629 (53.6%) were treated with primary cytoreductive surgery, 554 (18.2%) with NACT, and 854 (28.1%) received no treatment. Use of NACT increased from 9.5% to 29.2%. After NACT, interval hysterectomy was performed in 159 (28.6%), while within the PCS group, 1052 (64.6%) received chemotherapy. Extended cytoreductive procedures were performed in 71.7% of women who received NACT vs. 79.1% after PCS (P = 0.03). The complication rate was 52.8% for NACT versus 56.2% for PCS (P = 0.42); medical complications were more frequently seen in the PCS group (39.4% versus 28.9%; P = 0.01). There was no difference in cancer specific (P = 0.48) or overall survival (P = 0.25) in women who received both chemotherapy and surgery regardless of whether the initial treatment was NACT or PCS.
CONCLUSION
Use of NACT is increasing for advanced stage uterine cancer. There was no difference in survival between NACT and primary cytoreductive surgery and NACT was associated with fewer perioperative medical complications.
目的
新辅助化疗（NACT）已成为治疗 IV 期子宫癌的一种替代方法，可替代初始细胞减灭术（PCS）。我们研究了 NACT 和 PCS 治疗 IV 期子宫癌的应用、围手术期结局和生存率。
方法
利用监测、流行病学和最终结果-医疗保险数据库，确定了 2000 年至 2015 年期间接受治疗的 IV 期子宫癌女性患者。将患者分为 NACT 或 PCS 组。记录间隔性细胞减灭术（NACT 后）或化疗（PCS 后）。评估两组手术范围和围手术期结局。多变量比例风险模型和 Kaplan-Meier 分析用于检查生存率。
结果
在 3037 名女性中，1629 名（53.6%）接受了初始细胞减灭术治疗，554 名（18.2%）接受了 NACT 治疗，854 名（28.1%）未接受治疗。NACT 的使用率从 9.5%增加到 29.2%。在 NACT 后，159 名患者（28.6%）进行了间隔性子宫切除术，而在 PCS 组中，1052 名患者（64.6%）接受了化疗。接受 NACT 的女性中，71.7%的人接受了扩展细胞减灭术，而 PCS 组中，79.1%的人接受了扩展细胞减灭术（P=0.03）。NACT 的并发症发生率为 52.8%，PCS 为 56.2%（P=0.42）；PCS 组更常出现医疗并发症（39.4%比 28.9%；P=0.01）。接受化疗和手术的女性无论初始治疗是 NACT 还是 PCS，癌症特异性生存（P=0.48）或总体生存（P=0.25）均无差异。
结论
NACT 治疗 IV 期子宫癌的应用日益增加。NACT 与初始细胞减灭术的生存率无差异，NACT 与较少的围手术期医疗并发症相关。
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