医学
子宫内膜癌
淋巴血管侵犯
肿瘤科
阶段(地层学)
淋巴结切除术
内科学
辅助治疗
近距离放射治疗
妇科肿瘤学
外照射放疗
放射治疗
存活率
外科
作者
Ji-Won Son,Laura M. Chambers,Caitlin Carr,Chad M. Michener,Meng Yao,Anna Beavis,Ting Lin Yen,Rebecca L. Stone,Stephanie L. Wethington,Amanda N. Fader,Wesley C. Burkett,Debra J. Richardson,A. Staley,Susie Ahn,Paola A. Gehrig,Diogo Torres,Sean C. Dowdy,Mackenzie W. Sullivan,Susan C. Modesitt,Catherine Watson,Ashley Veade,Jessie Ehrisman,Laura J. Havrilesky,Angeles Alvarez Secord,Amy Loreen,Kaitlyn S. Griffin,Amanda L. Jackson,Akila N. Viswanathan,Stephanie Ricci
出处
期刊:International Journal of Gynecological Cancer
[BMJ]
日期:2020-08-07
卷期号:30 (11): 1738-1747
被引量:4
标识
DOI:10.1136/ijgc-2020-001454
摘要
Background Adjuvant therapy in early-stage endometrial cancer has not shown a clear overall survival benefit, and hence, patient selection remains crucial. Objective To determine whether women with high-intermediate risk, early-stage endometrial cancer with lymphovascular space invasion particularly benefit from adjuvant treatment in improving oncologic outcomes. Methods A multi-center retrospective study was conducted in women with stage IA, IB, and II endometrial cancer with lymphovascular space invasion who met criteria for high-intermediate risk by Gynecologic Oncology Group (GOG) 99. Patients were stratified by the type of adjuvant treatment received. Clinical and pathologic features were abstracted. Progression-free and overall survival were evaluated using multivariable analysis. Results 405 patients were included with the median age of 67 years (range 27–92, IQR 59–73). 75.0% of the patients had full staging with lymphadenectomy, and 8.6% had sentinel lymph node biopsy (total 83.6%). After surgery, 24.9% of the patients underwent observation and 75.1% received adjuvant therapy, which included external beam radiation therapy (15.1%), vaginal brachytherapy (45.4%), and combined brachytherapy + chemotherapy (19.1%). Overall, adjuvant treatment resulted in improved oncologic outcomes for both 5-year progression-free survival (77.2% vs 69.6%, HR 0.55, p=0.01) and overall survival (81.5% vs 60.2%, HR 0.42, p<0.001). After adjusting for stage, grade 2/3, and age, improved progression-free survival and overall survival were observed for the following adjuvant subgroups compared with observation: external beam radiation (overall survival HR 0.47, p=0.047, progression-free survival not significant), vaginal brachytherapy (overall survival HR 0.35, p<0.001; progression-free survival HR 0.42, p=0.003), and brachytherapy + chemotherapy (overall survival HR 0.30 p=0.002; progression-free survival HR 0.35, p=0.006). Compared with vaginal brachytherapy alone, external beam radiation or the addition of chemotherapy did not further improve progression-free survival (p=0.80, p=0.65, respectively) or overall survival (p=0.47, p=0.74, respectively). Conclusion Adjuvant therapy improves both progression-free survival and overall survival in women with early-stage endometrial cancer meeting high-intermediate risk criteria with lymphovascular space invasion. External beam radiation or adding chemotherapy did not confer additional survival advantage compared with vaginal brachytherapy alone.