Department of Radiation Oncology, University of Louisville, Louisville, KY, United States of America.
Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, KY, United States of America.
Gynecol Oncol. 2021 Dec;163(3):517-523. doi: 10.1016/j.ygyno.2021.09.006. Epub 2021 Sep 23.
The optimal treatment for medically inoperable endometrioid endometrial adenocarcinoma is unknown. The goal of this study was to evaluate the patterns of care and efficacy of radiotherapy (RT) or hormone therapy (HT) in the treatment of these patients.
We performed a query of the National Cancer Database (NCDB) of patients with medically inoperable endometrioid adenocarcinoma of the endometrium diagnosed between 2004 and 2016 and treated with either RT or HT. A multivariate Cox regression model and propensity weighted analyses were used to evaluate overall survival after controlling for confounding variables. A multinomial logistic regression model was used to assess predictors of RT or HT use.
A total of 1036 patients were included in this cohort, and 73% (n = 759) were treated with RT alone. Patients who received definitive HT compared to RT were more likely to be older, diagnosed in the earlier years of this analysis, treated at lower-case volume centers, diagnosed with high-grade disease, or located outside of metropolitan areas. On multivariate analysis, treatment with HT alone versus RT alone was associated with significantly worse overall survival in the multivariate Cox model but not on propensity score weighted analysis. Interaction effect testing revealed that older patients and those treated at lower-volume centers had improved survival with RT compared to HT.
We identified factors associated with the receipt of RT or HT in medically inoperable endometrial cancer patients. Treatment with RT correlated with improved survival compared to HT in older patients and those treated at lower-volume centers.
对于不能手术的子宫内膜样腺癌，最佳治疗方法尚不清楚。本研究的目的是评估放射治疗（RT）或激素治疗（HT）在这些患者治疗中的作用模式和疗效。
我们对 2004 年至 2016 年间诊断为不能手术的子宫内膜样腺癌且接受 RT 或 HT 治疗的患者进行了国家癌症数据库（NCDB）查询。采用多变量 Cox 回归模型和倾向评分加权分析来控制混杂因素后评估总生存情况。采用多项逻辑回归模型来评估 RT 或 HT 使用的预测因素。
共纳入 1036 例患者，73%（n=759）单独接受 RT 治疗。与 RT 相比，接受明确 HT 治疗的患者更有可能年龄较大、在本分析的早期被诊断、在低容量中心接受治疗、被诊断为高级别疾病或位于大都市以外的地区。多变量分析显示，与单独接受 RT 相比，单独接受 HT 治疗与总体生存较差显著相关，但在倾向评分加权分析中无此相关性。交互效应检验显示，与 HT 相比，在老年患者和低容量中心接受治疗的患者中，RT 治疗与生存改善相关。
我们确定了与不能手术的子宫内膜癌患者接受 RT 或 HT 治疗相关的因素。与 HT 相比，在老年患者和低容量中心接受治疗的患者中，RT 治疗与生存改善相关。
