Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.
Keck School of Medicine University of Southern California, Los Angeles, California, USA.
Int J Gynecol Cancer. 2024 Oct 7;34(10):1603-1611. doi: 10.1136/ijgc-2024-005718.
Given limited real-world practice data evaluating the National Comprehensive Cancer Network clinical practice guidelines for possible post-operative chemotherapy omission as a treatment option for patients with stage IC grade 1 endometrioid ovarian carcinoma, this population-based study examined the association between post-operative chemotherapy and overall survival in this tumor group.
The National Cancer Institute's Surveillance, Epidemiology, and End Results program was retrospectively queried. The study population was 1207 patients with stage IC grade 1-3 endometrioid ovarian carcinoma who received primary cancer-directed surgery from 2007 to 2020. Overall survival was assessed with multivariable Cox proportional hazard regression model.
The median age was 52, 54, and 55 years for grade 1, 2, and 3 groups, respectively (p=0.02). Grade 1 and 2 tumors were more common than grade 3 tumors (n=508 (42.1%), n=493 (40.8%), and n=206 (17.1%), respectively). Chemotherapy use rate for grade 1 tumors was lower compared with grade 2-3 tumors (67.9%, 76.5%, and 78.6%, respectively, p<0.001). When nodal evaluation was performed for grade 1 tumors, among patients who did not receive post-operative chemotherapy and among those who did, 5-year overall survival rate exceeded 90% (93.3% and 96.0%, respectively), with statistically non-significant hazard estimates (adjusted hazard ratio (aHR) 1.54, 95% CI 0.63 to 3.73). In contrast, post-operative chemotherapy omission for patients who did not undergo nodal evaluation was associated with decreased overall survival (5-year rates 82.3% vs 96.0%, aHR 5.41, 95% CI 1.95 to 15.06). Results were similar for node-evaluated grade 2 tumors (5-year overall survival rates, 94.6% and 94.4% for node-evaluated post-operative chemotherapy omission and administration, respectively), but not in grade 3 tumors.
The results of this population-based study may partially support the current clinical practice guidelines for post-operative chemotherapy omission as a possible option for patients with stage IC grade 1 endometrioid adenocarcinoma of the ovary for those who had lymph node evaluation. Observed data were also supportive for node-evaluated grade 2 tumors, warranting further evaluation.
鉴于目前关于美国国家综合癌症网络临床实践指南的真实世界实践数据有限，该指南建议将术后化疗作为 IC 期 G1 子宫内膜样卵巢癌患者的一种治疗选择，本研究基于人群的研究旨在检查在该肿瘤组中，术后化疗与总生存之间的关联。
通过回顾性查询美国国家癌症研究所的监测、流行病学和最终结果计划。研究人群为 2007 年至 2020 年间接受原发性癌症定向手术的 1207 名 IC 期 G1-3 子宫内膜样卵巢癌患者。采用多变量 Cox 比例风险回归模型评估总生存率。
G1、G2 和 G3 组的中位年龄分别为 52、54 和 55 岁（p=0.02）。G1 和 G2 肿瘤比 G3 肿瘤更常见（n=508（42.1%）、n=493（40.8%）和 n=206（17.1%））。与 G2-3 肿瘤相比，G1 肿瘤的化疗使用率较低（分别为 67.9%、76.5%和 78.6%，p<0.001）。在对 G1 肿瘤进行淋巴结评估时，在未接受术后化疗的患者和接受化疗的患者中，5 年总生存率均超过 90%（分别为 93.3%和 96.0%），且风险估计无统计学意义（调整后危险比（aHR）1.54，95%CI 0.63 至 3.73）。相反，对于未进行淋巴结评估的患者，术后化疗的遗漏与总生存率降低相关（5 年生存率分别为 82.3%和 96.0%，aHR 5.41，95%CI 1.95 至 15.06）。对于进行淋巴结评估的 G2 肿瘤，结果相似（分别为 94.6%和 94.4%），但对于 G3 肿瘤则不然。
本基于人群的研究结果可能部分支持目前的临床实践指南，对于进行了淋巴结评估的 IC 期 G1 卵巢子宫内膜样腺癌患者，术后化疗的遗漏作为一种可能的选择。观察到的数据也支持对 G2 肿瘤进行评估，值得进一步研究。
