Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.
Int J Gynecol Cancer. 2021 Dec;31(12):1549-1556. doi: 10.1136/ijgc-2021-002884. Epub 2021 Nov 1.
The role and type of adjuvant therapy for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIA grade 1 endometrioid endometrial adenocarcinoma are controversial. This retrospective cohort study aimed to determine associations between adjuvant therapy use and survival among patients with stage IIIA grade 1 endometrial cancer.
Patients who underwent primary surgery for stage IIIA (FIGO 2009 staging) grade 1 endometrial cancer between January 2004 and December 2016 were identified in the National Cancer Database. Demographics and receipt of adjuvant therapy were compared. Overall survival was analyzed using Kaplan-Meier curves, log-rank test, and multivariable Cox proportional hazard models.
Of 1120 patients, 248 (22.1%) received no adjuvant treatment, 286 (25.5%) received chemotherapy alone, 201 (18.0%) radiation alone, and 385 (34.4%) chemotherapy and radiation. Five-year overall survival rate was 83.0% (95% CI 80.1% to 85.6%). Older age, increasing comorbidity count, and lymphovascular space invasion status were significant negative predictors of survival. Over time, there was an increasing rate of chemotherapy (45.4% in 2004-2009 vs 69.2% in 2010-2016; p<0.001). In the multivariable analysis, chemotherapy was associated with significantly improved overall survival compared with no adjuvant therapy (HR 0.49 (95% CI 0.31 to 0.79); p=0.003). There was no survival association when comparing radiation alone with no treatment, and none when adding radiation to chemotherapy compared with chemotherapy alone. Those with lymphovascular space invasion (n=124/507) had improved overall survival with chemotherapy and radiation (5-year overall survival 91.2% vs 76.7% for chemotherapy alone and 27.3% for radiation alone, log-rank p<0.001), but there was no survival difference after adjusting for age and comorbidity (HR 0.25 (95% CI 0.05 to 1.41); p=0.12).
The use of adjuvant chemotherapy for the treatment of stage IIIA grade 1 endometrial cancer increased over time and was associated with improved overall survival compared with radiation alone or chemoradiation. Patients with lymphovascular space invasion may benefit from combination therapy.
国际妇产科联合会（FIGO）III 期 A 级 1 级子宫内膜样腺癌患者辅助治疗的作用和类型存在争议。本回顾性队列研究旨在确定 IIIA 期 1 级子宫内膜癌患者接受辅助治疗与生存之间的关系。
在国家癌症数据库中，确定了 2004 年 1 月至 2016 年 12 月期间接受 IIIA（FIGO 2009 分期）级 1 期子宫内膜癌初始手术治疗的患者。比较了人口统计学特征和接受辅助治疗的情况。使用 Kaplan-Meier 曲线、对数秩检验和多变量 Cox 比例风险模型分析总生存率。
在 1120 名患者中，248 名（22.1%）未接受辅助治疗，286 名（25.5%）单独接受化疗，201 名（18.0%）单独接受放疗，385 名（34.4%）接受化疗和放疗。5 年总生存率为 83.0%（95%CI80.1%至 85.6%）。年龄较大、合并症数量增加和脉管侵犯状态是生存的显著负预测因素。随着时间的推移，化疗的比例逐渐增加（2004-2009 年为 45.4%，2010-2016 年为 69.2%；p<0.001）。多变量分析显示，与无辅助治疗相比，化疗与总生存率显著提高（HR0.49（95%CI0.31 至 0.79）；p=0.003）。与无治疗相比，单独放疗与无治疗相比无生存关联，与单独化疗相比，加放疗与化疗相比也无生存关联。脉管侵犯患者（507 例中有 124 例）接受化疗和放疗后总生存率提高（5 年总生存率化疗联合组为 91.2%，化疗组为 76.7%，放疗组为 27.3%，对数秩检验 p<0.001），但调整年龄和合并症后无生存差异（HR0.25（95%CI0.05 至 1.41）；p=0.12）。
随着时间的推移，III 期 A 级 1 级子宫内膜癌患者辅助化疗的应用增加，并与单独放疗或放化疗相比，总生存率提高。脉管侵犯患者可能受益于联合治疗。
