II期和III期子宫平滑肌肉瘤辅助治疗的应用及结果

Utilization and outcomes of adjuvant therapy for stage II and III uterine leiomyosarcoma.

作者信息

Diggs Alexandra, Sia Tiffany Y, Huang Yongmei, Gockley Allison, Melamed Alexander, Khoury-Collado Fady, St Clair Caryn, Hou June Y, Hershman Dawn L, Wright Jason D

机构信息

Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; New York Presbyterian Hospital, United States of America.

Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.

出版信息

Gynecol Oncol. 2022 Aug;166(2):308-316. doi: 10.1016/j.ygyno.2022.05.018. Epub 2022 Jun 2.

DOI:10.1016/j.ygyno.2022.05.018

PMID:35660331

Abstract

OBJECTIVES

The optimal adjuvant therapy for uterine leiomyosarcoma (uLMS) remains uncertain. We analyzed the utilization of adjuvant chemotherapy and radiation therapy for stage II and III uLMS and explored the association between use of adjuvant therapy and survival.

METHODS

Patients with stage II or III uLMS treated from 2004 to 2016 and recorded in the National Cancer Database were identified. Multivariable regression models were fit to estimate predictors of use of either adjuvant radiation therapy or chemotherapy. To analyze the impact of chemotherapy on all-cause mortality, an inverse probability of treatment weighted (IPTW) propensity score method was used to account for measured confounders, and the receipt of radiation therapy was adjusted in the outcome model. The process was repeated to analyze the impact of radiation therapy on all-cause mortality by using an IPTW propensity score method and adjusting for the receipt of adjuvant chemotherapy.

RESULTS

A total of 890 patients were identified. Adjuvant chemotherapy use increased from 62.2% in 2010 to 70.4% in 2016, whereas radiation usage decreased from 26.7% in 2010 to 10.4% in 2016. Patients with stage III (vs. stage II) disease were less likely to receive radiation therapy. After propensity score weighting, chemotherapy was associated with a 30% decreased risk of all-cause mortality in stage III patients (HR 0.70, 95% CI 0.45-0.98) but had no effect on mortality for stage II patients (HR 0.93, 95% CI 0.70-1.20). Radiation therapy was associated with a 26% decreased risk of mortality for stage II tumors (HR 0.74; 95% CI, 0.53-0.99) and a 57% decrease in mortality for stage III disease (HR 0.43, 95% CI 0.18-0.99).

CONCLUSIONS

Among women with stage II-III uLMS, use of chemotherapy is increasing while use of radiation therapy is decreasing. Radiation therapy is associated with improved survival in both stage II and III disease, while there was no association between use of adjuvant chemotherapy and survival in stage II patients.

摘要

目的

子宫平滑肌肉瘤（uLMS）的最佳辅助治疗方案仍不明确。我们分析了II期和III期uLMS辅助化疗和放疗的使用情况，并探讨了辅助治疗的使用与生存之间的关联。

方法

确定2004年至2016年期间在国家癌症数据库中记录的II期或III期uLMS患者。采用多变量回归模型来估计辅助放疗或化疗使用的预测因素。为了分析化疗对全因死亡率的影响，使用治疗加权逆概率（IPTW）倾向评分方法来考虑测量到的混杂因素，并在结局模型中对放疗的接受情况进行调整。通过使用IPTW倾向评分方法并调整辅助化疗的接受情况，重复该过程以分析放疗对全因死亡率的影响。

结果

共识别出890例患者。辅助化疗的使用从2010年的62.2%增加到2016年的70.4%，而放疗的使用从2010年的26.7%下降到2016年的10.4%。III期（与II期相比）疾病患者接受放疗的可能性较小。在倾向评分加权后，化疗与III期患者全因死亡风险降低30%相关（HR 0.70，95% CI 0.45 - 0.98），但对II期患者的死亡率没有影响（HR 0.93，95% CI 0.70 - 1.20）。放疗与II期肿瘤患者死亡风险降低26%相关（HR 0.74；95% CI，0.53 - 0.99），与III期疾病患者死亡风险降低57%相关（HR 0.43，95% CI 0.18 - 0.99）。