我们是否应该放弃子宫内膜癌的激素治疗？孕激素治疗复发性和转移性子宫内膜癌的结局。
Should we abandon hormonal therapy in endometrial cancer? Outcomes of recurrent and metastatic endometrial cancer treated with systemic progestins.
机构信息
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
出版信息
Cancer Med. 2023 Aug;12(15):16173-16180. doi: 10.1002/cam4.6276. Epub 2023 Jul 7.
PURPOSE
The objective of this study is to determine primary survival endpoints in women with recurrent and metastatic endometrial carcinoma (RMEC) treated with progestins.
METHODS
A retrospective chart review was conducted at The Ottawa Hospital using electronic medical records. Inclusion criteria were a diagnosis of RMEC between 2000 and 2019, endometrioid histology, and ≥one line of progestin treatment. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method.
RESULTS
Of 2342 cases reviewed, 74 met inclusion criteria. Sixty-six (88.0%) patients received megestrol acetate and 9 (12.0%) received a progestin alternative. The distribution of tumors by grade was: 1: 25 (33.3%), 2: 30 (40.0%), and 3: 20 (26.7%). The PFS and OS for the entire study sample was 14.3 months (95% CI 6.2-17.9) and 23.3 months (14.8-36.8), respectively. The PFS for patients with Grade 1-2 RMEC was 15.7 months (8.0, 19.5), compared to 5.0 months (3.0, 23.0) with Grade 3 disease. The OS for patients with Grade 1-2 versus Grade 3, was 25.9 months (15.3, 40.3) versus 12.5 months (5.7, 35.9), respectively. Thirty-four (45.9%) and 40 (54.1%) patients were treated with 0 and ≥1 line of chemotherapy. The PFS for chemotherapy-naïve patients was 17.9 months (14.3, 27.0), versus 6.2 months (3.9, 14.8) following ≥1 line of treatment. The OS was 29.1 months (17.9, 61.1) for chemotherapy-naïve patients versus 23.0 months (10.5, 37.6) for patients previously exposed.
CONCLUSIONS
This real-world data on RMEC suggests there is a role for progestins in select subgroups of women. The PFS for chemotherapy-naïve patients was 17.9 months (14.3, 27.0), versus 6.2 months (3.9, 14.8) following ≥1 line of treatment. The OS was 29.1 months (17.9, 61.1) for chemotherapy-OS was 29.1 months (17.9, 61.1) for chemotherapy-naïve patients versus 23.0 months (10.5, 37.6) for patients previously exposed.
目的
本研究旨在确定接受孕激素治疗的复发性和转移性子宫内膜癌（RMEC）女性的主要生存终点。
方法
使用电子病历在渥太华医院进行回顾性图表审查。纳入标准为 2000 年至 2019 年间诊断为 RMEC、子宫内膜样组织学和≥一线孕激素治疗的患者。使用 Kaplan-Meier 方法估计无进展生存期（PFS）和总生存期（OS）。
结果
在审查的 2342 例病例中，有 74 例符合纳入标准。66 例（88.0%）患者接受醋酸甲地孕酮治疗，9 例（12.0%）患者接受孕激素替代治疗。肿瘤分级分布为：1 级：25 例（33.3%），2 级：30 例（40.0%），3 级：20 例（26.7%）。整个研究样本的 PFS 和 OS 分别为 14.3 个月（95%CI 6.2-17.9）和 23.3 个月（14.8-36.8）。1-2 级 RMEC 患者的 PFS 为 15.7 个月（8.0，19.5），而 3 级疾病患者为 5.0 个月（3.0，23.0）。1-2 级与 3 级患者的 OS 分别为 25.9 个月（15.3，40.3）和 12.5 个月（5.7，35.9）。34 例（45.9%）和 40 例（54.1%）患者接受了 0 线和≥1 线化疗。化疗初治患者的 PFS 为 17.9 个月（14.3，27.0），而≥1 线治疗后为 6.2 个月（3.9，14.8）。化疗初治患者的 OS 为 29.1 个月（17.9，61.1），而既往暴露患者为 23.0 个月（10.5，37.6）。
结论
本 RMEC 的真实世界数据表明孕激素在某些亚组女性中具有作用。化疗初治患者的 PFS 为 17.9 个月（14.3，27.0），而≥1 线治疗后为 6.2 个月（3.9，14.8）。OS 为 29.1 个月（17.9，61.1），化疗初治患者的 OS 为 29.1 个月（17.9，61.1），而既往暴露患者的 OS 为 23.0 个月（10.5，37.6）。
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