Arizona Oncology (US Oncology Network), University of Arizona, Creighton University, Phoenix, AZ, USA.
University of Arizona College of Medicine, Phoenix, AZ, USA.
Gynecol Oncol. 2022 Feb;164(2):325-332. doi: 10.1016/j.ygyno.2021.12.008. Epub 2021 Dec 21.
To characterize clinical outcomes of women with advanced/recurrent endometrial cancer (AEC) in routine practice using electronic health records from a real-world database.
Adult women diagnosed with AEC (stage III/IV, or early stage with locoregional/distant recurrence) between January 1, 2013 and September 30, 2020, inclusive, were eligible provided they received platinum-based chemotherapy at any time following diagnosis and had ≥2 clinical visits. Follow-up was from initiation of systemic treatment after advanced diagnosis (index) until March 30, 2021, last available follow-up, or death, whichever occurred first. Outcomes, by histological subtype, included Kaplan-Meier estimates of overall survival (OS) and time to first subsequent therapy or death (TFST).
Of the 2202 women with AEC, most were treated in a community setting (82.7%) and presented with stage III/IV disease at initial diagnosis (74.0%). The proportion with endometrioid carcinoma, uterine serous carcinoma (USC), and other AEC subtypes was 59.8%, 25.0%, and 15.2%, respectively. The most common first systemic treatment following advanced/recurrent diagnosis was platinum-based combination chemotherapy (82.0%). Median OS (95% CI) from initiation of first systemic treatment was shorter with USC (31.3 [27.7-34.3] months) and other AECs (29.4 [21.4-43.9] months) versus endometrioid carcinoma (70.8 [60.5-83.2] months). Similar results were observed for TFST. Black/African American women had worse OS and TFST than white women.
Women with AEC had poor survival outcomes, demonstrating the requirement for more effective therapies. To our knowledge, this is the most comprehensive evaluation of contemporary treatment of AEC delivered in a community setting to date.
利用真实世界数据库中的电子健康记录，描述晚期/复发性子宫内膜癌（AEC）女性患者的临床结局特征。
本研究纳入了 2013 年 1 月 1 日至 2020 年 9 月 30 日期间被诊断为 AEC（III/IV 期，或早期局部/远处复发）的成年女性患者，只要在诊断后接受过任何时间的铂类为基础的化疗且至少有 2 次临床就诊，即可入组。随访从晚期诊断后开始全身性治疗（索引）至 2021 年 3 月 30 日、最后一次可用随访或任何原因导致的死亡，以先发生者为准。根据组织学亚型，观察总生存期（OS）和首次后续治疗或死亡时间（TFST）的 Kaplan-Meier 估计值等结局。
在 2202 名 AEC 女性患者中，大多数患者在社区环境中接受治疗（82.7%），且在初始诊断时为 III/IV 期疾病（74.0%）。子宫内膜样癌、子宫浆液性癌（USC）和其他 AEC 亚型的比例分别为 59.8%、25.0%和 15.2%。在晚期/复发性诊断后，最常见的一线系统性治疗是铂类联合化疗（82.0%）。从首次全身治疗开始，USC（31.3 [27.7-34.3] 个月）和其他 AEC （29.4 [21.4-43.9] 个月）的中位 OS（95%CI）短于子宫内膜样癌（70.8 [60.5-83.2] 个月）。TFST 也观察到类似的结果。黑人/非裔美国女性的 OS 和 TFST 均较白人女性差。
AEC 女性患者的生存结局较差，表明需要更有效的治疗方法。据我们所知，这是迄今为止对社区环境中 AEC 进行的最全面的当代治疗评估。
