Departments of Radiation Oncology.
Obstetrics and Gynecology.
Am J Clin Oncol. 2022 Jan 1;45(1):36-39. doi: 10.1097/COC.0000000000000871.
The objective of this study was to determine if deficiency of mismatch repair (dMMR) proteins in patients with early-stage favorable endometrial cancer treated with vaginal brachytherapy (VB) is associated with increased recurrence.
A multi-institutional retrospective cohort study of 141 patients with stage I to II grade 1 and 2 endometrioid adenocarcinoma treated with surgery and adjuvant VB was performed to compare recurrence risk in dMMR (n=41) versus MMR-preserved (pMMR) (n=100). Additional clinical and pathologic risk factors were also collected. Univariate analysis and multivariable analysis Cox regression analysis was performed to identify factors associated with any recurrence. Kaplan-Meier method and log rank test were used to compare recurrence free survival and overall survival (OS).
Median follow up was 42 months. Forty-one patients (29%) were dMMR. There were 7 recurrences (17%) in dMMR versus 4 recurrences (4%) in pMMR (P=0.009). On univariate analysis of any recurrence, both dMMR (hazard ratio: 5.3, P=0.008) and stage (hazard ratio: 3.8, P=0.05) were statistically significantly associated with time to first recurrence. The 5-year recurrence free survival was 90% (95% CI: 73%-96%) in pMMR versus 61.0% (95% CI: 19%-86%) in dMMR (P=0.003). Five-year OS was 96% (95% CI: 76%-99%) in pMMR versus 86% (95% CI: 62%-95%) in dMMR (P=0.03).
MMR deficiency in stage I to II grade 1 to 2 endometrial cancer patients treated with adjuvant VB alone was associated with statistically significant increased risk for any recurrence and worse OS. MMR status may be an important prognosticator in this cohort of patients warranting adjuvant treatment intensification in the clinical trial setting.
本研究旨在确定在接受阴道近距离放疗（VB）治疗的早期预后良好的子宫内膜癌患者中，错配修复（dMMR）蛋白缺陷是否与复发增加有关。
对 141 例接受手术和辅助 VB 治疗的 I 期至 II 期 1 级和 2 级子宫内膜样腺癌患者进行了多机构回顾性队列研究，比较了 dMMR（n=41）与错配修复保留（pMMR）（n=100）患者的复发风险。还收集了其他临床和病理危险因素。采用单因素分析和多因素分析 Cox 回归分析确定与任何复发相关的因素。采用 Kaplan-Meier 法和对数秩检验比较无复发生存率和总生存率（OS）。
中位随访时间为 42 个月。41 例患者（29%）为 dMMR。dMMR 中有 7 例（17%）复发，pMMR 中有 4 例（4%）复发（P=0.009）。在任何复发的单因素分析中，dMMR（风险比：5.3，P=0.008）和分期（风险比：3.8，P=0.05）均与首次复发时间有统计学显著相关性。pMMR 的 5 年无复发生存率为 90%（95%CI：73%-96%），dMMR 为 61.0%（95%CI：19%-86%）（P=0.003）。pMMR 的 5 年 OS 为 96%（95%CI：76%-99%），dMMR 为 86%（95%CI：62%-95%）（P=0.03）。
在接受单纯辅助 VB 治疗的 I 期至 II 期 1 级至 2 级子宫内膜癌患者中，MMR 缺陷与任何复发风险显著增加和 OS 较差相关。MMR 状态可能是该患者队列中的一个重要预后因素，需要在临床试验中强化辅助治疗。
