Gynecologic Oncology, Catholic Health Services of Long Island, Rockville Centre, New York, USA
Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.
Int J Gynecol Cancer. 2022 Nov 7;32(11):1402-1409. doi: 10.1136/ijgc-2022-003717.
To evaluate differences in survival and recurrence patterns in stage I-IV uterine carcinosarcoma patients treated with surgery followed by adjuvant chemotherapy alone, radiation alone, or a combination of both chemotherapy and radiation therapy.
A multicenter retrospective analysis of patients with surgically staged carcinosarcoma receiving adjuvant therapy from January 2000 to December 2019 was conducted. Inclusion criteria were patients with carcinosarcoma who had received primary surgical treatment, followed by adjuvant therapy with chemotherapy alone, radiation therapy alone, or a combination of chemoradiation. Patients were excluded for incomplete surgical staging data, adjuvant brachytherapy alone, adjuvant chemotherapy and brachytherapy without external beam radiation therapy, receipt of neoadjuvant chemotherapy and/or pre-operative pelvic radiation, and death due to non-cancer causes. Sites of recurrence were analyzed by adjuvant treatment modality using Pearson's χ test. Progression-free and overall survival were calculated using Kaplan-Meier estimates. Multivariate analysis was performed using Cox proportional hazards model.
Of 176 evaluable patients, 27% (n=47) had stage I, 14% (n=24) stage II, 37% (n=66) stage III, and 22% (n=39) stage IV disease. Among them, 33% (n=59) received chemotherapy alone, 17% (n=29) received radiation therapy alone, and 50% (n=88) received chemoradiation. Patients with stage I disease recurred less frequently (64%) versus stage II (83%), stage III (85%), and stage IV (90%) (p<0.001). Stage I disease demonstrated improved progression-free and overall survival relative to all other stages (p<0.01). Across all stages, patients receiving chemoradiation experienced superior progression-free (p=0.01) and overall survival (p=0.05) versus single modality therapy. However, when analyzed in a stage-specific manor, stage III disease derived the greatest survival benefit from chemoradiation versus all other stages (p<0.01). On multivariant analysis, only stage and receipt of chemoradiation were independent predictors of survival.
Stage I disease demonstrated improved survival compared with other stages regardless of adjuvant treatment modality. Chemoradiation was associated with improved survival and better distant and local disease control for all stages of disease. Patients with stage III disease derived the most benefit from chemoradiation.
评估手术联合辅助化疗、单纯放疗或化疗联合放疗治疗 I-IV 期子宫癌肉瘤患者的生存和复发模式差异。
对 2000 年 1 月至 2019 年 12 月接受辅助治疗的手术分期癌肉瘤患者进行多中心回顾性分析。纳入标准为接受原发手术治疗后接受辅助化疗、单纯放疗或化疗联合放疗的癌肉瘤患者。排除标准为手术分期资料不完整、单纯辅助近距离放疗、单纯化疗联合无外照射放疗、新辅助化疗和/或术前盆腔放疗、以及因非癌症原因死亡的患者。采用 Pearson χ 检验分析辅助治疗方式与复发部位的关系。采用 Kaplan-Meier 估计法计算无进展生存期和总生存期。采用 Cox 比例风险模型进行多因素分析。
在 176 例可评估患者中，27%（n=47）为 I 期、14%（n=24）为 II 期、37%（n=66）为 III 期、22%（n=39）为 IV 期。其中，33%（n=59）接受单纯化疗、17%（n=29）接受单纯放疗、50%（n=88）接受化疗联合放疗。I 期疾病的复发率（64%）明显低于 II 期（83%）、III 期（85%）和 IV 期（90%）（p<0.001）。与所有其他分期相比，I 期疾病的无进展生存期和总生存期均有所改善（p<0.01）。在所有分期中，接受放化疗的患者无进展生存期（p=0.01）和总生存期（p=0.05）优于单模态治疗。然而，在按分期进行的分析中，III 期疾病从放化疗中获益最大，与其他所有分期相比，差异均有统计学意义（p<0.01）。多变量分析显示，只有分期和接受放化疗是生存的独立预测因素。
与其他分期相比，I 期疾病的生存情况有所改善，而辅助治疗方式对其影响不大。放化疗可改善所有分期疾病的生存，并更好地控制远处和局部疾病。III 期疾病患者从放化疗中获益最大。
