Improved overall survival with adjuvant radiotherapy for high-intermediate and high risk Stage I endometrial cancer
Improved overall survival with adjuvant radiotherapy for high-intermediate and high risk Stage I endometrial cancer
复制标题
DOI：
10.1016/j.radonc.2016.12.003
复制
发表时间：
2017-03-01
影响因子：
5.7
通讯作者：
Grover, Surbhi
中科院分区：
文献类型：
--
作者：
Harkenrider, Matthew M.;Adams, William;Grover, Surbhi
背景/目的：对I期子宫内膜样型子宫内膜癌患者进行大量分析，以确定辅助放疗（ART）对生存的影响。材料/方法：132976例经手术治疗的FIGO期子宫内膜样型子宫内膜癌患者在由美国癌症委员会组成的国家癌症数据库（NCDB）中被确定。患者分为观察组（OBS）或ART组（阴道近距离放疗、外束放疗或两者兼而有之）。使用单变量广义线性混合效应模型来估计接受抗逆转录病毒治疗的几率，并使用多变量脆弱生存模型来估计接受OBS与ART的患者的瞬时死亡风险。由于存在显著的相互作用，这些估计值按基于portec的低、低、中、高和高风险组分层。结果：104,645例（79%）接受了OBS， 28,331例（21%）接受了ART。在接受ART治疗的患者中，12913例（46%）单独接受VBT治疗，12857例（45%）单独接受EBRT治疗，2561例（9%）接受EBRT + VBT治疗。在单变量分析中，分期/肌层浸润增加、分级高、年龄大、存在淋巴血管间隙浸润和肿瘤大小较大预示较差的生存（均< 0.01）。在多变量分析中，高、中危和高危患者接受ART治疗后生存率提高，风险比分别为0.796 （95% CI: 0.731-0.867; rho < 0.001）和0.783 （95% CI: 0.693-0.885; rho < 0.001）。在低或中低风险的患者中，抗逆转录病毒治疗没有生存获益。结论：在I期高、中、高危子宫内膜样型子宫内膜癌患者中，ART可显著提高总生存率。2016爱思唯尔爱尔兰有限公司版权所有。
Background/purpose: To perform a large analysis of Stage I endometrioid-type endometrial cancer patients to determine the impact of adjuvant radiotherapy (ART) on survival.Material/methods: 132,976 FIGO Stage I endometrioid-type endometrial cancer patients treated surgically were identified within the National Cancer Database (NCDB) comprising Commission on Cancer facilities in the United States. Patients were categorized as observation (OBS) or ART (vaginal brachytherapy, external beam radiotherapy, or both). Univariable generalized linear mixed effects models were used to estimate the odds of receiving ART, and a multivariable frailty survival model was used to estimate the instantaneous hazard of death for those receiving OBS versus ART. Due to the presence of a significant interaction, these estimates were stratified by PORTEC-based low, low-intermediate, high intermediate, and high risk groups.Results: 104,645 (79%) underwent OBS while 28,331 (21%) received ART. Of those receiving ART, 12,913 (46%) received VBT alone, 12,857 (45%) received EBRT alone, and 2561 (9%) received EBRT + VBT. On univariable analysis, increasing stage/myometrial invasion, higher grade, older age, presence of lymphovascular space invasion, and larger tumor size predicted poorer survival (all rho < 0.01). On multivariable analysis, patients at high-intermediate risk and high risk experienced improved survival with ART with a hazard ratio of 0.796 (95% CI: 0.731-0.867; rho < 0.001) and 0.783 (95% CI: 0.693-0.885; rho < 0.001), respectively. There was no survival benefit for ART among patients at low or low -intermediate risk.Conclusions: In Stage I high -intermediate and high risk endometrioid-type endometrial cancer patients, ART significantly improves overall survival. (C) 2016 Elsevier Ireland Ltd. All rights reserved.