Lander Megan E, Vargo John, Li Runjia, Balasubramani G K, Buckanovich Ron, Lesnock Jamie, Garrett Alison, Rush Shannon, Sukumvanich Paniti
Division of Gynecologic Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Gynecol Oncol Rep. 2025 May 6;59:101756. doi: 10.1016/j.gore.2025.101756. eCollection 2025 Jun.
High-risk Endometrial Cancer (EC) treatment decisions have been informed by two large, randomized trials: GOG-258 and PORTEC-3. Directly comparing these studies to determine the optimal treatment strategy remains challenging as neither included all three arms of interest: chemotherapy alone, chemotherapy combined with radiation, and radiation therapy alone. This study addresses this gap by analyzing National Cancer Database (NCDB) data to evaluate the comparative effectiveness of chemotherapy alone, chemoradiotherapy, and radiation therapy alone.
The NCDB was queried for patients with stage II-IVa endometrioid and any stage clear cell or serous EC who underwent primary surgery with hysterectomy between 2004 and 2020. Univariable and multivariable models investigated prognostic factors and overall survival. Propensity weighted analysis adjusted for potential indication bias.
48,831 patients met inclusion criteria. 19,251 received no adjuvant treatment, 8,076 received adjuvant radiation only, 13,418 received adjuvant chemotherapy only, 1,849 received adjuvant concurrent chemoradiation, and 6,237 received adjuvant sequential chemotherapy and radiation. Factors independently associated with improved survival included adjuvant treatment modality, age, race, insurance status, histology, grade, stage, facility type, facility location, and residential setting. Multivariate propensity weighted analysis showed concurrent and sequential chemoradiation significantly improved OS (HR 0.69, 95 % CI 0.0.60-0.80, p < 0.001; HR 0.63, 95 % CI 0.59-0.67, p < 0.001).
Chemoradiation is associated with improved OS in high-risk EC patients regardless of various factors. This data suggests chemoradiation as a preferred treatment option, however, prospective trials directly comparing chemotherapy, radiation, and chemoradiation are needed for confirmation.
两项大型随机试验为高危子宫内膜癌（EC）的治疗决策提供了依据：GOG - 258和PORTEC - 3。直接比较这些研究以确定最佳治疗策略仍然具有挑战性，因为这两项试验均未涵盖所有三个感兴趣的治疗组：单纯化疗、化疗联合放疗以及单纯放疗。本研究通过分析国家癌症数据库（NCDB）数据来评估单纯化疗、放化疗和单纯放疗的相对疗效，以填补这一空白。
查询NCDB中2004年至2020年间接受子宫切除术为主的原发性手术的II - IVa期子宫内膜样癌以及任何分期的透明细胞或浆液性EC患者。单变量和多变量模型研究了预后因素和总生存期。倾向加权分析对潜在的指征偏倚进行了调整。
48,831例患者符合纳入标准。19,251例未接受辅助治疗，8,076例仅接受辅助放疗，13,418例仅接受辅助化疗，1,849例接受辅助同步放化疗，6,237例接受辅助序贯化疗和放疗。与生存期改善独立相关的因素包括辅助治疗方式、年龄、种族、保险状况、组织学类型、分级、分期、机构类型、机构位置和居住环境。多变量倾向加权分析显示同步和序贯放化疗显著改善了总生存期（风险比0.69，95%置信区间0.60 - 0.80，p < 0.001；风险比0.63，95%置信区间0.59 - 0.67, p < 0.001）。
无论各种因素如何，放化疗与高危EC患者总生存期的改善相关。该数据表明放化疗是一种首选的治疗选择，然而，需要进行直接比较化疗、放疗和放化疗的前瞻性试验来加以证实。
