Anastasio Mary Katherine, Nolin Angela, Penvose Katherine N, Lambert Katherine, Li Jessie, Ledbetter Leila, Davidson Brittany A, Havrilesky Laura J, Albright Benjamin B
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA.
Gynecol Oncol. 2024 Dec;191:10-18. doi: 10.1016/j.ygyno.2024.09.011. Epub 2024 Sep 20.
To summarize practice patterns and outcomes among patients with non-myoinvasive high-grade (formerly stage IA, now stage IC) endometrial cancer.
We conducted a systematic search using MEDLINE, Embase, Cochrane, Web of Science, and ClinicalTrials.gov databases from inception to May 8, 2024 to identify studies reporting on treatment and outcomes of non-myoinvasive high-grade endometrial cancer. We included full-text English reports of patients undergoing adjuvant therapy or surveillance for polyp- or endometrium-confined high-grade endometrial cancer without myometrial invasion containing data on recurrence or survival outcomes. Two reviewers independently screened studies; a third reviewer resolved disagreements. Data were extracted using a standardized form. The primary outcome was recurrence risk. Random-effects meta-analysis was used to summarize binomial proportions and to compare outcomes by adjuvant treatment strategy.
A total of 29 studies were included, representing 2770 unique patients. Overall, 49.0 % of patients were managed with observation and 37.9 % with chemotherapy. Most patients (92.5 %) had serous histology. Of 23 studies with data on recurrence, 13.7 % of patients recurred, with a meta-analysis estimate recurrence risk of 11 % (95 % confidence interval [CI]: 8-15 %). Across 13 studies reporting on recurrence by receipt of chemotherapy versus no chemotherapy, comparative meta-analysis showed similar likelihood of recurrence (8.0 % versus 13.2 %; odds ratio 0.73, 95 % CI: 0.38-1.42). Comparative meta-analyses for (1) adjuvant therapy versus observation and (2) observation or vaginal brachytherapy versus chemotherapy and/or external beam radiation therapy demonstrated no statistically significant difference in recurrence risk. Sensitivity analyses results, including those limiting to studies of patients with serous histology (12 studies) or complete surgical staging (10 studies), were overall consistent with the primary analysis. Survival data was inconsistently reported and not amenable to meta-analysis.
Among patients with non-myoinvasive high-grade endometrial cancer, recurrence risk was 11 % and use of adjuvant therapy was not associated with reduced recurrence risk. Prospective study of this population is warranted.
总结非肌层浸润性高级别（原IA期，现IC期）子宫内膜癌患者的治疗模式及结局。
我们从数据库建库至2024年5月8日，使用MEDLINE、Embase、Cochrane、Web of Science和ClinicalTrials.gov数据库进行系统检索，以识别报告非肌层浸润性高级别子宫内膜癌治疗及结局的研究。我们纳入了接受辅助治疗或监测的息肉样或局限于子宫内膜的高级别子宫内膜癌患者的英文全文报告，这些患者无肌层浸润，包含复发或生存结局数据。两名审阅者独立筛选研究；第三名审阅者解决分歧。使用标准化表格提取数据。主要结局为复发风险。采用随机效应荟萃分析来汇总二项比例，并按辅助治疗策略比较结局。
共纳入29项研究，代表2770例独特患者。总体而言，49.0%的患者接受观察治疗，37.9%接受化疗。大多数患者（92.5%）为浆液性组织学类型。在23项有复发数据的研究中，13.7%的患者复发，荟萃分析估计复发风险为11%（95%置信区间[CI]：8 - 15%）。在13项报告接受化疗与未接受化疗患者复发情况的研究中，比较性荟萃分析显示复发可能性相似（8.0%对13.2%；比值比0.73，95%CI：0.38 - 1.42）。对（1）辅助治疗与观察以及（2）观察或阴道近距离放射治疗与化疗和/或外照射放疗的比较性荟萃分析显示，复发风险无统计学显著差异。敏感性分析结果，包括限于浆液性组织学类型患者（12项研究）或完全手术分期患者（10项研究）的分析，总体与初步分析一致。生存数据报告不一致，不适合进行荟萃分析。
在非肌层浸润性高级别子宫内膜癌患者中，复发风险为11%，辅助治疗的使用与降低复发风险无关。对该人群进行前瞻性研究是必要的。
