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指南一致的治疗可改善高级别子宫内膜癌患者的生存。

Guideline concordant therapy improves survival in high-grade endometrial cancer patients.

机构信息

Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.

Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany.

出版信息

J Cancer Res Clin Oncol. 2023 Jul;149(8):4761-4769. doi: 10.1007/s00432-022-04318-1. Epub 2022 Oct 14.

DOI:10.1007/s00432-022-04318-1
PMID:36239795
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10349781/
Abstract

PURPOSE

Data from randomized controlled trials in high-grade endometrial cancer are scarce due to its low prevalence. Therefore, guideline recommendations in this cancer subtype rely on relatively few randomized trials and data from retrospective studies. The aim of this study was to evaluate the benefits from guideline-concordant therapy in high-grade endometrial cancer in a real-world patient group.

METHODS

The effect of treatment according to German S3 guidelines and the former S2k guideline on overall survival (OS) and recurrence-free survival (RFS) was evaluated in a cohort of 293 high-grade endometrial cancer patients.

RESULTS

Treatment concordant with the S3 guideline significantly improved OS (HR 0.623, CI 0.420-0.923, p = 0.018) and RFS (HR 0.578, CI 0.387-0.863, p = 0.007). Treatment concordant with the S2k guideline did not result in a significantly higher OS (HR 0.783, CI 0.465-1.316, p = 0.335) or RFS (HR 0.741, CI 0.347-1.740, p = 0.242).

CONCLUSION

Therapy according to the German S3 guideline improved OS and RFS in univariate as well as multivariate analysis in this cohort of high-grade endometrial cancer patients.

摘要

目的

由于高级别子宫内膜癌的发病率较低，因此其随机对照试验数据稀缺。因此，该癌症亚型的指南建议主要依赖于相对较少的随机试验和回顾性研究的数据。本研究旨在评估在真实患者群体中，遵循指南的治疗方案对高级别子宫内膜癌的获益。

方法

本研究评估了 293 名高级别子宫内膜癌患者中，根据德国 S3 指南和前 S2k 指南进行治疗对总生存期（OS）和无复发生存期（RFS）的影响。

结果

与 S3 指南一致的治疗显著改善了 OS（HR 0.623，CI 0.420-0.923，p=0.018）和 RFS（HR 0.578，CI 0.387-0.863，p=0.007）。与 S2k 指南一致的治疗并未显著提高 OS（HR 0.783，CI 0.465-1.316，p=0.335）或 RFS（HR 0.741，CI 0.347-1.740，p=0.242）。

结论

在本高级别子宫内膜癌患者队列中，S3 指南指导的治疗在单变量和多变量分析中均提高了 OS 和 RFS。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3813/11797281/47bb2cc2891b/432_2022_4318_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3813/11797281/22705a71c4de/432_2022_4318_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3813/11797281/143842bdb112/432_2022_4318_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3813/11797281/c210cc75d55f/432_2022_4318_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3813/11797281/47bb2cc2891b/432_2022_4318_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3813/11797281/22705a71c4de/432_2022_4318_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3813/11797281/143842bdb112/432_2022_4318_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3813/11797281/c210cc75d55f/432_2022_4318_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3813/11797281/47bb2cc2891b/432_2022_4318_Fig4_HTML.jpg

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Gynecol Oncol. 2020 Jun;157(3):716-722. doi: 10.1016/j.ygyno.2020.03.016. Epub 2020 Mar 23.
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Guideline-concordant chemotherapy in patients with hormone receptor-positive and node-positive, early breast cancer leads to better overall and metastases-free survival with limited benefit in elderly patients.激素受体阳性和淋巴结阳性的早期乳腺癌患者接受符合指南的化疗可改善总生存和无转移生存，而老年患者的获益有限。
Arch Gynecol Obstet. 2020 Feb;301(2):573-583. doi: 10.1007/s00404-019-05387-3. Epub 2019 Nov 20.
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Guideline-concordant endometrial cancer treatment and survival in the Women's Health Initiative Life and Longevity After Cancer study.
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Int J Cancer. 2020 Jul 15;147(2):404-412. doi: 10.1002/ijc.32740. Epub 2019 Oct 31.
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Phase III Trial: Adjuvant Pelvic Radiation Therapy Versus Vaginal Brachytherapy Plus Paclitaxel/Carboplatin in High-Intermediate and High-Risk Early Stage Endometrial Cancer.III 期临床试验：辅助盆腔放疗与紫杉醇/卡铂阴道近距离放疗治疗中高危早期子宫内膜癌。
J Clin Oncol. 2019 Jul 20;37(21):1810-1818. doi: 10.1200/JCO.18.01575. Epub 2019 Apr 17.
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Arch Gynecol Obstet. 2019 Apr;299(4):1131-1140. doi: 10.1007/s00404-018-5030-z. Epub 2019 Jan 4.
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