McEachron Jennifer, Zhou Nancy, Hastings Victoria, Bennett Michelle, Gorelick Constantine, Kanis Margaux J, Lee Yi-Chun
Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center - Catholic Health, Long Island, NY, United States.
Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States.
Cancer Treat Res Commun. 2022;33:100631. doi: 10.1016/j.ctarc.2022.100631. Epub 2022 Sep 2.
The prognosis of patients presenting with stage IVB uterine serous carcinoma (USC) remains extremely poor, with a reported 5-year survival of <20%. Here were evaluate the survival impact of cytoreductive surgery and identify other prognostic factors in stage IVB USC.
A multicenter retrospective analysis of patients with stage IVB USC was conducted from 2000 to 2018. Inclusion criteria were patients who had undergone comprehensive surgical staging/tumor debulking; followed by adjuvant chemotherapy+/-external beam radiation therapy (EBRT). Optimal cytoreduction (R1) was defined as residual disease ≤1 cm at completion of surgery, and suboptimal cytoreduction (R2) was defined as >1 cm. Progression free survival (PFS) and overall survival (OS) analysis was performed using Kaplan-Meier estimates. Multivariate analysis (MVA) was performed using Cox proportional hazards model.
Final analysis included 68 patients. There was no difference in the frequency of treatment delays between regimens (p = 0.832). 96% of patients received platinum-based chemotherapy. There was no difference in the age (p = 0.227), race (p = 0.936), type of radiotherapy (p = 0.852) or chemotherapy regimen received (p = 0.996) between R1 and R2 cohorts. The median PFS for all patients was 8 months and the median OS was 13 months. Cytoreduction to R1 was associated with a median PFS of 9 months, compared to R2 with a median PFS of 4 months (p < 0.001, HR 0.32, 95% CI 7.4-14.1). Median OS was also improved with R1 vs. R2 cytoreduction (17 months vs. 7 months, respectively) (p < 0.001, HR 0.21, 95% CI 13.7-26.4). Compared to R1, cytoreduction to R0 was not associated with a survival benefit. The R0 median OS was 17 months versus 18 months in R1 (p = 0.67). The combination of adjuvant chemoradiation was associated with improved PFS (11 months vs. 7 months) (p = 0.024, HR 0.41, 95% CI 6.5-9.4) and OS (22 months vs 13 months) (p = 0.65, HR 0.25, 95% CI 10.5-15.4) compared to chemotherapy-alone, respectively. On MVA, only the amount of residual disease (p = 0.003, HR 0.39, 95% CI 0.2-0.7) and receipt of adjuvant chemoradiation (p = 0.010, HR 0.09, 95% CI 0.01-0.58) were independent predictors of survival.
In stage IVB USC, optimal cytoreduction should be the goal at the time of primary surgery. The combination of chemoradiation was associated with superior survival compared to chemotherapy alone and should be further investigated in this patient population.
IVB期子宫浆液性癌（USC）患者的预后仍然极差，据报道其5年生存率<20%。在此，我们评估了肿瘤细胞减灭术对生存的影响，并确定IVB期USC的其他预后因素。
对2000年至2018年期间的IVB期USC患者进行了多中心回顾性分析。纳入标准为接受了全面手术分期/肿瘤细胞减灭术的患者；随后接受辅助化疗±体外放射治疗（EBRT）。最佳细胞减灭（R1）定义为手术结束时残留病灶≤1 cm，次优细胞减灭（R2）定义为>1 cm。采用Kaplan-Meier估计法进行无进展生存期（PFS）和总生存期（OS）分析。使用Cox比例风险模型进行多变量分析（MVA）。
最终分析纳入68例患者。各治疗方案之间的治疗延迟频率无差异（p = 0.832）。96%的患者接受了铂类化疗。R1和R2队列之间在年龄（p = 0.227）、种族（p = 0.936）、放疗类型（p = 0.852）或接受的化疗方案（p = 0.996）方面无差异。所有患者的中位PFS为8个月，中位OS为13个月。细胞减灭至R1与中位PFS为9个月相关，而R2的中位PFS为4个月（p < 0.001，HR 0.32，95%CI 7.4 - 14.1）。R1细胞减灭与R2相比，中位OS也有所改善（分别为17个月和7个月）（p < 0.001，HR 0.21，95%CI
