Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Gynecol Oncol. 2022 Jun;165(3):428-436. doi: 10.1016/j.ygyno.2022.03.021. Epub 2022 Apr 19.
To examine population-level trends, characteristics, and outcomes of patients with stage IVB endometrial cancer who received neoadjuvant chemotherapy (NACT) prior to surgery.
The National Cancer Institute's Surveillance, Epidemiology, and End Results Program was retrospectively queried by examining 5505 patients with stage IVB endometrial cancer from 2010 to 2018. Exposure allocation was per treatment: primary surgery followed by chemotherapy (n = 3052, 55.4%), NACT followed by surgery (n = 930, 16.9%), and chemotherapy alone (n = 1523, 27.7%). Main outcomes measured were (i) the trend of utilization of NACT and patient characteristics related to NACT assessed with multinomial regression analysis and (ii) overall survival (OS) assessed with multivariable Cox proportional hazards regression model.
The number of patients receiving NACT prior to surgery increased from 11.6% to 21.7% whereas those undergoing primary surgery followed by chemotherapy decreased from 62.7% to 48.3% (P < 0.001). Increasing utilization of NACT remained independent in multivariable analysis (adjusted-odds ratio per one-year increments 1.11, 95% confidence interval [CI] 1.08-1.15). Increasing utilization of NACT was observed in several sub-cohorts including patients aged <65 years, ≥65 years, White, non-White, endometrioid, non-endometrioid, and cases with non-distant organ metastasis (P < 0.05). In a multivariable analysis, NACT followed by surgery and primary surgery followed by chemotherapy had comparable OS (median 25 versus 26 months, adjusted-hazard ratio [HR] 1.03, 95%CI 0.93-1.15). When examined for metastatic extent, NACT followed by surgery was associated with decreased OS compared to primary surgery followed by chemotherapy in the non-distant organ metastasis group (adjusted-HR 1.20, 95%CI 1.05-1.36) whereas it was associated with improved OS in the distant organ metastasis group (adjusted-HR 0.79, 95%CI 0.66-0.95).
The treatment of stage IVB endometrial cancer is shifting from primary surgery to NACT in the United States.
研究接受新辅助化疗（NACT）后再手术的 IVB 期子宫内膜癌患者的人群水平趋势、特征和结局。
通过检查 2010 年至 2018 年期间 5505 名 IVB 期子宫内膜癌患者，对美国国立癌症研究所的监测、流行病学和最终结果计划进行了回顾性查询。暴露分配按治疗方式进行：初次手术加化疗（n=3052，55.4%）、NACT 加手术（n=930，16.9%）和单纯化疗（n=1523，27.7%）。主要观察终点为：（i）NACT 使用率的趋势以及通过多项回归分析评估的与 NACT 相关的患者特征；（ii）通过多变量 Cox 比例风险回归模型评估总生存（OS）。
接受术前 NACT 的患者人数从 11.6%增加到 21.7%，而接受初次手术加化疗的患者人数从 62.7%减少到 48.3%（P<0.001）。多变量分析显示，NACT 使用率的增加仍然独立（每增加一年的调整优势比为 1.11，95%置信区间[CI]为 1.08-1.15）。在几个亚组中观察到 NACT 使用率的增加，包括年龄<65 岁、≥65 岁、白种人、非白种人、子宫内膜样、非子宫内膜样和无远处器官转移的病例（P<0.05）。在多变量分析中，NACT 加手术和初次手术加化疗的 OS 相当（中位 25 个月与 26 个月，调整后的危险比[HR]为 1.03，95%CI 为 0.93-1.15）。在检查转移范围时，与初次手术加化疗相比，无远处器官转移组中 NACT 加手术与 OS 降低相关（调整后的 HR 为 1.20，95%CI 为 1.05-1.36），而在远处器官转移组中与 OS 改善相关（调整后的 HR 为 0.79，95%CI 为 0.66-0.95）。
美国 IVB 期子宫内膜癌的治疗正在从初次手术向 NACT 转移。
