Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2024 Nov;190:236-242. doi: 10.1016/j.ygyno.2024.08.019. Epub 2024 Sep 7.
To determine the impact of adjuvant therapy on oncologic outcomes in patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IA, IB, or II endometrial clear cell carcinoma (ECCC).
We conducted a retrospective review at 4 international institutions. Patients with newly diagnosed clinical stage I or II disease of either clear cell or mixed histology with a clear cell component treated between 01/01/2000-12/31/2015 were included. Oncologic outcomes were assessed for patients based on adjuvant treatment received, including chemotherapy, radiation, or chemotherapy with radiation.
Of 125 patients identified and analyzed, 77 (61.6%) had clear cell histology and 118 (94.4%) had stage I disease. Median age at diagnosis was 65 years (range, 33-91). All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and lymph node assessment. Twenty-five patients (20.0%) underwent surgical management alone and 100 (80.0%) received adjuvant therapy: 20 (16.0%) received postoperative chemotherapy, 47 (37.6%) received postoperative radiation, and 33 (26.4%) received postoperative chemotherapy with radiation. Median follow-up was 88.4 months (range, <1-234). Progression-free survival (PFS) or overall survival (OS) did not significantly differ between surgery alone and type of adjuvant therapy (P = 0.18 and P = 0.56, respectively). Patients with mixed ECCC did not have a survival advantage over those with pure ECCC (5-year PFS rate, 85.0% vs 82.7%, P = 0.77; 5-year OS rate, 88.3% vs 91.2%, P = 0.94).
Receipt of adjuvant therapy in surgically staged I/II ECCC did not appear to offer a survival advantage over observation alone. Adjuvant therapy in early-stage ECCC with consideration of molecular classification should be evaluated.
确定辅助治疗对 2009 年国际妇产科联合会（FIGO）分期 IA、IB 或 II 期子宫内膜透明细胞癌（ECCC）患者肿瘤学结局的影响。
我们在 4 家国际机构进行了回顾性研究。纳入了 2000 年 1 月 1 日至 2015 年 12 月 31 日期间接受治疗的新诊断为 I 期或 II 期疾病的单纯透明细胞或混合组织学且具有透明细胞成分的患者。根据接受的辅助治疗（包括化疗、放疗或化疗联合放疗）评估患者的肿瘤学结局。
共纳入并分析了 125 例患者，其中 77 例（61.6%）为透明细胞组织学，118 例（94.4%）为 I 期疾病。诊断时的中位年龄为 65 岁（范围，33-91 岁）。所有患者均接受了子宫切除术、双侧附件切除术和淋巴结评估。25 例（20.0%）仅接受手术治疗，100 例（80.0%）接受了辅助治疗：20 例（16.0%）接受术后化疗，47 例（37.6%）接受术后放疗，33 例（26.4%）接受术后化疗联合放疗。中位随访时间为 88.4 个月（范围，<1-234 个月）。单纯手术与辅助治疗类型之间的无进展生存期（PFS）或总生存期（OS）无显著差异（P=0.18 和 P=0.56）。混合性 ECCC 患者的生存优势并不优于单纯性 ECCC 患者（5 年 PFS 率，85.0%比 82.7%，P=0.77；5 年 OS 率，88.3%比 91.2%，P=0.94）。
在接受手术分期的 I/II 期 ECCC 患者中，接受辅助治疗似乎并不优于单纯观察。应评估考虑分子分类的早期 ECCC 辅助治疗。
