Moldovan Nataliya, Lambert Pascal, Ong Aldrich, Altman Alon D
Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
Department of Epidemiology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
Int J Gynecol Cancer. 2022 Oct 3;32(10):1258-1265. doi: 10.1136/ijgc-2021-003210.
Our study aimed to analyze recurrence and survival outcomes in stage II endometrial cancer patients treated with adjuvant radiotherapy at CancerCare Manitoba, a Canadian provincial cancer program.
This retrospective population-based cohort study identified all International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid type endometrial carcinoma diagnosed between January 1995 and December 2019. All patients underwent surgery followed by vaginal vault brachytherapy alone or external beam pelvic radiotherapy plus vaginal vault brachytherapy. We used Kaplan-Meier curves to describe overall survival and recurrence-free survival, and cumulative incidence to describe recurrence. Cox regression was used to predict overall survival and recurrence-free survival competing risk regression to predict recurrence.
A total of 121 patients were included (78 vaginal brachytherapy alone and 43 external beam pelvic radiotherapy plus vaginal brachytherapy) with a median age of 62 (range 24-85). The median follow-up was 55.2 months (range 7.1-147.9) in the vaginal brachytherapy group and 41.9 months (range 7.4-127.0) in the pelvic radiotherapy group. Lymph node dissection was performed in 79 (65.3%) patients. There were 14 (17.9%) recurrences (8 vaginal vault, 3 pelvic, 3 distant) with vaginal brachytherapy and 7 (16.3%) recurrences (3 vaginal vault, 2 pelvic, 2 distant) with external beam pelvic radiotherapy. The 5 year overall survival was 73.1% with vaginal vault brachytherapy vs 73.7% with external beam pelvic radiotherapy plus vaginal brachytherapy (p=0.31), the 5 year recurrence-free survival was 65.0% vs 68.2% (p=0.61), and the 5 year recurrence risk was 20.3% vs 19.4% (p=0.94). On univariable and multivariable analysis, only age was a statistically significant predictor for overall survival and recurrence-free survival (p<0.05), but not lymphovascular space invasion (HR, 2.97; 95% CI, 0.99 to 8.93 for overall survival, p=0.15). The type of adjuvant radiotherapy did not predict for recurrence (p=0.94).
There was no significant difference in overall survival, recurrence-free survival, and recurrence risk between vaginal vault brachytherapy vs external beam pelvic radiotherapy plus vaginal vault brachytherapy in patients with stage II endometrial cancer.
我们的研究旨在分析加拿大省级癌症项目曼尼托巴癌症关爱中心接受辅助放疗的II期子宫内膜癌患者的复发情况和生存结局。
这项基于人群的回顾性队列研究纳入了1995年1月至2019年12月期间确诊的所有国际妇产科联盟（FIGO）2009分期的II期子宫内膜样型子宫内膜癌患者。所有患者均接受手术，随后单独进行阴道穹窿近距离放疗或盆腔外照射放疗加阴道穹窿近距离放疗。我们使用Kaplan-Meier曲线描述总生存期和无复发生存期，使用累积发病率描述复发情况。采用Cox回归预测总生存期和无复发生存期，采用竞争风险回归预测复发情况。
共纳入121例患者（78例单独接受阴道近距离放疗，43例接受盆腔外照射放疗加阴道近距离放疗），中位年龄为62岁（范围24 - 85岁）。阴道近距离放疗组的中位随访时间为55.2个月（范围7.1 - 147.9个月），盆腔放疗组为41.9个月（范围7.4 - 127.0个月）。79例（65.3%）患者进行了淋巴结清扫。单独阴道近距离放疗组有14例（17.9%）复发（8例阴道穹窿复发，3例盆腔复发，3例远处复发），盆腔外照射放疗加阴道近距离放疗组有7例（16.3%）复发（3例阴道穹窿复发，2例盆腔复发，2例远处复发）。单独阴道穹窿近距离放疗的5年总生存率为73.1%，盆腔外照射放疗加阴道穹窿近距离放疗为73.7%（p = 0.31）；5年无复发生存率分别为65.0%和68.2%（p = 0.61）；5年复发风险分别为20.3%和19.4%（p = 0.94）。单因素和多因素分析显示，只有年龄是总生存期和无复发生存期的统计学显著预测因素（p < 0.05），而淋巴血管间隙浸润不是（总生存期的HR为2.97；95%CI为0.99至8.93，p = 0.15）。辅助放疗类型不能预测复发（p = 0.94）。
II期子宫内膜癌患者中，阴道穹窿近距离放疗与盆腔外照射放疗加阴道穹窿近距离放疗在总生存期、无复发生存期和复发风险方面无显著差异。
