The role of multi-modality adjuvant chemotherapy and radiation in women with advanced stage endometrial cancer
The role of multi-modality adjuvant chemotherapy and radiation in women with advanced stage endometrial cancer
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DOI：
10.1016/j.ygyno.2007.06.014
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发表时间：
2007-11-01
影响因子：
4.7
通讯作者：
Gehrig, Paola A.
中科院分区：
文献类型：
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作者：
Secord, Angeles Alvarez;Havrilesky, Laura J.;Gehrig, Paola A.
Objective. III期和IV期子宫内膜癌患者在手术分期和细胞减灭术后的最佳辅助治疗仍存在争议。我们试图确定晚期子宫内膜癌患者术后化疗和放疗的结果，以确定联合治疗方式是否有优势。回顾性分析了1975年至2006年杜克大学和北卡罗来纳州大学的III期和IV期子宫内膜癌患者。入选标准为综合分期手术，包括子宫切除术、双侧输卵管卵巢切除术、选择性盆腔/主动脉淋巴结切除术、手术减积和辅助化疗和/或放疗治疗。采用Kaplan-Meier法和考克斯比例风险模型分析无进展生存期（PFS）和总生存期（OS）。确定了356例接受术后辅助治疗的晚期子宫内膜癌患者; 48%（n=171）单纯放疗，29%（n=102）单纯化疗，23%（n=83）化疗和放疗。中位年龄为66岁; 38%为恶性类胶质瘤; 83%为最佳减容。辅助治疗组之间的OS和PFS存在显著差异（p < 0.001），与单独放疗（70%和59%）或联合治疗（79%和62%）相比，单独接受化疗的患者的3年OS（33%）和PFS（19%）较差。在调整分期、年龄、分级和减瘤状态后，与联合治疗相比，单独化疗的OS风险比（HR）为1.60（95% CI，0.88至2.89; p=0.122），单独放疗为2.01（95% CI，1.17至3.48; p=0.012）。当分析仅限于最佳减容患者时，仅接受化疗或放疗的患者的校正HR表明疾病进展风险显著较高[HR= 1.84（95% CI，1.03 - 3.27; p=0.038）; HR= 1.80（95%CI，1.10至2.95; p=0.020）]和死亡[HR=2.33（95%CI，1.12至4.86; p=0.024）; HR=2.64（95%CI，1.38至5.07; p=0.004）]。联合辅助化疗和放疗与改善晚期疾病患者的生存率相关，与单独使用任何一种方法相比。未来的临床试验需要前瞻性地评估晚期子宫内膜癌患者的多模式辅助治疗，以确定适当的化疗和放疗的顺序和类型。(c)2007年由Elsevier Inc.出版
Objective. The optimal adjuvant therapy for women with stages III and IV endometrial cancer following surgical staging and cytoreductive surgery is controversial. We sought to determine the outcome of patients with advanced stage endometrial cancer treated with postoperative chemotherapy radiation to determine whether there was an advantage to combining treatment modalities.Methods. A retrospective analysis of patients with surgical stages III and IV endometrial cancer from 1975 to 2006 was conducted at Duke University and the University of North Carolina. Inclusion criteria were comprehensive staging procedure including hysterectomy, bilateral salpingo-oophorectomy, selective pelvic/aortic lymphadenectomy, surgical debulking, and treatment with adjuvant chemotherapy and/or radiotherapy. Progression-free (PFS) and overall survival (OS) were analyzed using Kaplan-Meier method and Cox proportional hazards model.Results. 356 Patients with advanced stage endometrial cancer were identified who received postoperative adjuvant therapies; 48% (n=171) radiotherapy alone, 29% (n=102) chemotherapy alone, 23% (n=83) chemotherapy and radiation. The median age was 66 years; 38% bad endometrioid tumors; and 83% were optimally debulked. There was a significant difference between the adjuvant treatment groups for both OS and PFS (p < 0.001), with those receiving chemotherapy alone having poorer 3-year OS (33%) and PFS (19%) compared to either radiotherapy alone (70% and 59%) or combination therapy (79% and 62%). After adjusting for stage, age, grade, and debulking status the hazard ratio (HR) for OS was 1.60 (95% CI, 0.88 to 2.89; p=0.122) for chemotherapy alone and 2.01 (95% CI, 1.17 to 3.48; p=0.012) for radiotherapy alone, compared to combination therapy. When the analysis was restricted to optimally debulked patients the adjusted HR for patients who were treated with either chemotherapy or radiation alone indicated a significantly higher risk for disease progression [HR= 1.84 (95% CI, 1.03 to 3.27; p=0.038); HR= 1.80 (95% CI, 1.10 to 2.95; p=0.020)] and death [HR=2.33 (95% CI, 1.12 to 4.86; p=0.024); HR=2.64 (95% CI, 1.38 to 5.07; p=0.004)], respectively, compared to patients who received combination therapy.Conclusion. Combined adjuvant chemotherapy and radiation was associated with improved survival in patients with advanced stage disease compared to either modality alone. Future clinical trials are needed to prospectively evaluate multi-modality adjuvant therapy in women with advanced staged endometrial cancer to determine the appropriate sequencing and types of chemotherapy and radiation. (c) 2007 Published by Elsevier Inc.