Platinum/Taxane-based Chemotherapy With or Without Radiation Therapy Favorably Impacts Survival Outcomes in Stage I Uterine Papillary Serous Carcinoma
Platinum/Taxane-based Chemotherapy With or Without Radiation Therapy Favorably Impacts Survival Outcomes in Stage I Uterine Papillary Serous Carcinoma
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DOI：
10.1002/cncr.24247
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发表时间：
2009-05-15
期刊：
影响因子：
6.2
通讯作者：
Zanotti, Kristine M.
中科院分区：
文献类型：
--
作者：
Fader, Amanda Nickles;Drake, Richard D.;Zanotti, Kristine M.
背景：一项研究旨在确定I期子宫乳头状浆液性癌（UPSC）患者的复发模式和生存结果。方法：对1993年至2006年诊断的I期UPSC患者进行回顾性、多机构研究。患者接受全面的手术分期；术后治疗包括观察（OBS）；单纯放疗（RT）；结果：作者确定了142例患者，中位随访37个月（范围7-144个月）。观察33例患者，单纯RT治疗20例，CT +/- RT治疗89例。确诊复发25例（17.6%），其中盆腔外复发占60%。接受化疗的患者的复发率明显低于未接受化疗的患者（P = 0.013）。具体而言，CT RT患者的复发风险（11.2%）低于单独接受RT （25%, P = 0.146）或OBS （30.3%, P = 0.016）的患者。这种效果在IB/IC期最为明显（P =.007）。CT和CT + rt治疗的患者复发相似，经多因素分析，化疗与复发风险降低相关（P = 0.047）。大多数复发（88%）无法挽救。化疗患者的无进展生存期（PFS）和病因特异性生存期（CSS）比未接受化疗的患者更有利（P = 0.013和0.081）。CT RT组5年PFS和CSS分别为81.5%和87.6%，单独RT组为64.1%和59.5%，OBS组为64.7%和70.2%。结论：I期UPSC患者盆腔外复发风险显著，生存期较差。分期良好的患者接受铂/紫杉烷为基础的化疗可改善复发和生存。这项多机构研究是支持对早期UPSC患者进行全身治疗的最大研究。癌症2009;115:2119-27。(C) 2009年美国癌症协会。
BACKGROUND: A study was undertaken to determine recurrence patterns and survival outcomes of stage I uterine papillary serous carcinoma (UPSC) patients. METHODS: A retrospective, multi-institutional study of stage I UPSC patients diagnosed from 1993 to 2006 was performed. Patients underwent comprehensive surgical staging; postoperative treatment included observation (OBS); radiotherapy alone (RT); or platinum/taxane-based chemotherapy (CT) RT. RESULTS: The authors identified 142 patients with a median follow-up of 37 months (range, 7-144 months). Thirty-three patients were observed, 20 received RT alone, and 89 received CT +/- RT. Twenty-five recurrences (17.6%) were diagnosed, and 60% were extrapelvic. Chemotherapy-treated patients experienced significantly fewer recurrences than those treated without chemotherapy (P = .013). Specifically, CT RT patients had a lower risk of recurrence (11.2%) compared with patients who received RT alone (25%, P = .146) or OBS (30.3%, P = .016). This effect was most pronounced in stage IB/IC (P =.007). CT- and CT + RT-treated patients experienced similar recurrence, After multivariate analysis, treatment with chemotherapy was associated with a decreased risk of recurrence (P = .047). The majority of recurrences (88%) were not salvageable. Progression-free survival (PFS) and cause-specific survival (CSS) for chemotherapy-treated patients were more favorable than for those who did not receive chemotherapy (P = .013 and .081). Five-year PFS and CSS rates were 81.5% and 87.6% in CT RT, 64.1% and 59.5% in RT alone, and 64.7% and 70.2% for OBS. CONCLUSIONS: Stage I UPSC patients have significant risk for extrapelvic recurrence and poor survival. Recurrence and survival outcomes are improved in well-staged patients treated with platinum/taxane-based chemotherapy. This multi-institutional study is the largest to support systemic therapy for early stage UPSC patients. Cancer 2009;115:2119-27. (C) 2009 American Cancer Society.