Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
Gynecol Oncol. 2022 Jun;165(3):522-529. doi: 10.1016/j.ygyno.2022.04.007. Epub 2022 Apr 22.
To evaluate whether the addition of radiation to adjuvant chemotherapy is associated with improved survival in women with stage IV endometrial cancer following surgery.
The National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results Program (SEER) registries were queried for patients with stage IV endometrial cancer from 2004 to 2017. Treatment was categorized as chemotherapy alone, chemotherapy with external beam radiation therapy (EBRT), chemotherapy with vaginal brachytherapy (VBT), or chemotherapy with EBRT+VBT. Multivariable Cox regression models assessed associations between treatment modality and overall survival (OS).
This analysis included 17,890 (NCDB: 12,812, SEER: 5078) women with stage IV endometrial cancer, including 1757 (9.8%) with IVA disease and 16,133 (90.2%) with IVB. The majority of stage IV patients received chemotherapy alone (NCDB 78.8%, SEER 77.0%). When radiation was utilized in addition to chemotherapy, EBRT was most common (NCDB 15.8%, SEER: 15.4%). In both databases, use of any radiation in addition to chemotherapy was associated with improved OS. Stage IV patients treated with chemotherapy plus EBRT had better survival than those receiving chemotherapy alone [NCDB: HR 0.75 (95% CI 0.70, 0.79), SEER: HR 0.85 (95% CI 0.77, 0.94)]. This benefit was more pronounced in patients with IVA disease [NCDB: HR 0.66 (95% CI 0.55, 0.79), SEER: HR 0.63 (95% CI 0.46, 0.85)]. In histology-stratified analyses, the addition of radiation to chemotherapy was associated with improved OS in all histologies, except clear cell.
In this analysis of the NCDB and SEER registries, the use of multimodality treatment with radiation and chemotherapy was associated with improved OS compared to chemotherapy alone in women with stage IVA and IVB endometrial cancer.
评估在手术后，对于 IV 期子宫内膜癌患者，在辅助化疗的基础上增加放射治疗是否能改善生存。
从 2004 年至 2017 年，通过国家癌症数据库（NCDB）和监测、流行病学和最终结果计划（SEER）登记处查询 IV 期子宫内膜癌患者。治疗方法分为单独化疗、化疗联合外照射放疗（EBRT）、化疗联合阴道近距离放疗（VBT）或化疗联合 EBRT+VBT。多变量 Cox 回归模型评估治疗方式与总生存（OS）之间的关系。
本分析纳入了 17890 例（NCDB：12812 例，SEER：5078 例）IV 期子宫内膜癌患者，其中 1757 例（9.8%）为 IVA 期疾病，16133 例（90.2%）为 IVB 期。大多数 IV 期患者接受单独化疗（NCDB 78.8%，SEER 77.0%）。当在化疗的基础上增加放射治疗时，EBRT 最为常见（NCDB 15.8%，SEER：15.4%）。在两个数据库中，与单独化疗相比，任何形式的放射治疗联合化疗均可改善 OS。接受化疗联合 EBRT 治疗的 IV 期患者比接受单纯化疗的患者生存更好[NCDB：HR 0.75（95%CI 0.70，0.79），SEER：HR 0.85（95%CI 0.77，0.94）]。IVA 期患者的获益更为显著[NCDB：HR 0.66（95%CI 0.55，0.79），SEER：HR 0.63（95%CI 0.46，0.85）]。在组织学分层分析中，除透明细胞癌外，在所有组织学类型中，与单独化疗相比，化疗联合放射治疗均与 OS 改善相关。
在这项对 NCDB 和 SEER 登记处的分析中，与单独化疗相比，IVA 和 IVB 期子宫内膜癌患者采用放射治疗联合化疗的多模式治疗与 OS 改善相关。
