Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8461, Japan.
Department of Gynecology, National Cancer Center Hospital East, Chiba, Japan.
Int J Clin Oncol. 2024 Sep;29(9):1380-1390. doi: 10.1007/s10147-024-02560-w. Epub 2024 Jun 19.
Endometrial carcinoma, the most common gynecologic carcinoma, has an excellent prognosis post-surgery when diagnosed early. The role of postoperative adjuvant chemotherapy in stages I-II endometrial carcinoma remains controversial. This study assesses the efficacy of adjuvant chemotherapy in improving prognosis for these patients.
A retrospective analysis was conducted on 1223 stage I-II endometrial carcinoma patients who underwent surgical treatment including total hysterectomy, bilateral salpingo-oophorectomy, and lymph-node biopsy or dissection across four Jikei University School of Medicine-affiliated facilities between 2001 and 2018. Patients were divided into low intermediate risk (LIR) and high intermediate risk (HIR) groups based on recurrence risk. Propensity score matching adjusted for various covariates was used to compare progression-free survival (PFS) and overall survival (OS) between patients who received adjuvant chemotherapy and those who did not.
The study included 443 eligible patients, with 288 in the LIR group and 155 in the HIR group. Post propensity score matching, no significant difference in PFS or OS was observed between the observation and adjuvant chemotherapy groups within both risk categories. Notably, the 5-year OS for LIR was 97.6% in the observation group and 96.7% in the chemotherapy group; for HIR, the 5-year OS was similarly high with no significant difference.
The findings suggest that postoperative adjuvant chemotherapy does not significantly contribute to the improvement of recurrence or prognosis in patients with stage I-II endometrial carcinoma who are categorized outside the low-risk group and have no lymph-node metastasis.
子宫内膜癌是最常见的妇科恶性肿瘤，早期诊断、手术后患者预后良好。对于 I 期和 II 期子宫内膜癌患者，术后辅助化疗的作用仍存在争议。本研究旨在评估辅助化疗对改善这些患者预后的效果。
对 2001 年至 2018 年期间在四家顺天堂大学附属医院接受包括全子宫切除术、双侧输卵管卵巢切除术和淋巴结活检或解剖术在内的手术治疗的 1223 例 I 期和 II 期子宫内膜癌患者进行回顾性分析。根据复发风险将患者分为低中危组（LIR）和高中危组（HIR）。采用倾向评分匹配法调整各种协变量，比较接受辅助化疗和未接受辅助化疗的患者的无进展生存期（PFS）和总生存期（OS）。
本研究共纳入 443 例符合条件的患者，其中 LIR 组 288 例，HIR 组 155 例。在进行倾向评分匹配后，在两个风险组中，观察组和辅助化疗组之间的 PFS 或 OS 均无显著差异。值得注意的是，LIR 组的 5 年 OS 观察组为 97.6%，化疗组为 96.7%；HIR 组的 5 年 OS 也相似，无显著差异。
研究结果表明，对于低危组且无淋巴结转移的 I 期和 II 期子宫内膜癌患者，术后辅助化疗并不能显著改善复发或预后。
