Heidinger Martin, Simonnet Elisa, Koh Li Mei, Frey Tirri Brigitte, Vetter Marcus
Women's Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland.
University of Basel, Petersplatz 1, 4001 Basel, Switzerland.
J Bone Oncol. 2023 May 15;41:100485. doi: 10.1016/j.jbo.2023.100485. eCollection 2023 Aug.
Bone metastases (BM) are uncommon in endometrial carcinoma (EC), without information on the optimal oncologic management of patients with BM in EC. Here, we systematically review clinical characteristics, treatment approaches and prognosis in patients with BM in EC.
We conducted a systematic literature search until 27th March 2022 on PubMed, MEDLINE, Embase and clinicaltrials.gov. Outcomes included treatment frequency and survival after BM with comparators being treatment approaches (local cytoreductive bone surgery, systemic therapy, and local radiotherapy). Risk of bias was assessed using the NIH Quality Assessment Tool and Navigation Guide methodology.
We retrieved 1096 records of which 112 retrospective studies (12 cohort studies, 12/12 fair quality; 100 case studies, 100/100 low quality) with a total of 1566 patients were included. The majority had a primary diagnosis of FIGO stage IV, grade 3 endometrioid EC. Singular BM were present in a median of 39.2%, multiple BM in 60.8% and synchronous additional distant metastases in 48.1% of patients respectively. In patients with secondary BM median time to bone recurrence was 14 months. Median survival after BM was 12 months. Local cytoreductive bone surgery was assessed in 7/13 cohorts and performed in a median of 15.8% (interquartile range [IQR] 10.3-43.0) of patients. Chemotherapy was assessed in 11/13 cohorts and administered in a median of 55.5% (IQR 41.0-63.9), hormonal therapy (7/13 cohorts) in 24.7% (IQR 16.3-36.0), and osteooncologic therapy (4/13 cohorts) in 2.7% (IQR 0.0-7.5) of patients respectively. Local radiotherapy was assessed in 9/13 cohorts and performed in a median of 66.7% (IQR 55.6-70.0) of patients. Survival benefits were seen in 2/3 cohorts after local cytoreductive bone surgery, and in 2/7 cohorts after chemotherapy without survival benefits in the remaining cohorts and investigated therapies. Limitations include the lack of controlled intervention studies, the heterogeneity and retrospective nature of the investigated populations.
This systematic review shows heterogenous therapeutic approaches in clinical practice without clear evidence for optimal oncologic management for patients with BM in EC.
骨转移（BM）在子宫内膜癌（EC）中并不常见，目前尚无关于EC合并BM患者最佳肿瘤治疗方案的相关信息。在此，我们系统回顾了EC合并BM患者的临床特征、治疗方法及预后情况。
我们在PubMed、MEDLINE、Embase和clinicaltrials.gov上进行了系统的文献检索，截至2022年3月27日。研究结果包括BM后的治疗频率和生存率，比较的治疗方法有局部减瘤性骨手术、全身治疗和局部放疗。使用美国国立卫生研究院质量评估工具和导航指南方法评估偏倚风险。
我们检索到1096条记录，其中纳入了112项回顾性研究（12项队列研究，质量均为中等；100项病例研究，质量均较低），共1566例患者。大多数患者的原发诊断为国际妇产科联盟（FIGO）IV期、3级子宫内膜样EC。分别有39.2%的患者出现单个BM，60.8%的患者出现多个BM，48.1%的患者出现同步的其他远处转移。在发生继发性BM的患者中，骨复发的中位时间为14个月。BM后的中位生存期为12个月。在13个队列中的7个队列中评估了局部减瘤性骨手术，接受该手术的患者中位数为15.8%（四分位间距[IQR]为10.3 - 43.0）。在13个队列中的11个队列中评估了化疗，接受化疗的患者中位数为55.5%（IQR为41.0 - 63.9），接受激素治疗的患者（13个队列中的7个队列）为24.7%（IQR为16.3 - 36.0），接受骨肿瘤治疗的患者（13个队列中的4个队列）为2.7%（IQR为0.0 - 7.5）。在13个队列中的9个队列中评估了局部放疗，接受放疗的患者中位数为66.7%（IQR为55.6 - 70.0）。在2/3的队列中，局部减瘤性骨手术后观察到生存获益；在2/7的队列中，化疗后观察到生存获益，其余队列及所研究的治疗方法均未观察到生存获益。局限性包括缺乏对照干预研究、所研究人群的异质性和回顾性性质。
本系统评价显示临床实践中的治疗方法存在异质性，对于EC合并BM的患者，尚无明确证据支持最佳肿瘤治疗方案。
