DataSheet_1_Impact of the adjuvant management and risk factors on survival in FIGO stage 3 endometrial cancer patients.docx

ObjectivePatients with FIGO stage III endometrial cancer routinely receive adjuvant therapy. The purpose of this study was to evaluate overall survival (OS) and disease-free survival (DFS) in patients with stage IIIA to IIIC2 patients by treatment modality received and risk factors.
Materials/methodsPatients with stage III endometrial cancer treated from 2000-2010 were identified in the provincial cancer registry. Clinicopathologic characteristics, adjuvant treatments and outcomes were compared using descriptive and multivariable analyses.
Results261 patients had stage 3 endometrial cancer, 132 with stage IIIA, 9 with IIIB, 85 with IIIC1 and 35 with IIIC2. 39 had FIGO grade 1 disease; 73, grade 2; 147, grade 3. 160 had endometrioid and 35 had serous carcinoma. 161 patients received sequential adjuvant chemotherapy (CT) and radiotherapy (RT); 33 received RT only; 32 received CT only; 35 received neither. 5-year (5Y) DFS and OS were similar among stage IIIA (DFS 46.7%, OS 58.5%), IIIB (DFS 50.8%, OS 58.5%), IIIC1 (DFS 44%, OS 49.9%) and IIIC2 (DFS 42%, OS 41.6%). Use of adjuvant RT was associated with improved median DFS (53.7 vs 14.7m, p<0.00001) and OS (61.9 vs 25.7m, p<0.00001) compared to no RT. Likewise, use of adjuvant CT was also associated with improved DFS (54.8 vs 16.5m, p<0.00001) and OS (62.9 vs 26.5m, p<0.00001) compared to no CT. Those who received both chemotherapy and radiotherapy had better outcomes with 5-year DFS (58.3%) and OS (65.2%), compared with those who received monotherapy. On multivariate analysis, grade 3 disease, deep myometrial invasion >50%, and no adjuvant RT or CT were identified as adversely impacting DFS and OS.
ConclusionIn stage III endometrial cancer patients, use of both chemotherapy and radiation therapy was associated with improved DFS and OS and therefore should be recommended in all eligible patients after resection.

【研究目的】国际妇产科联盟（International Federation of Gynecology and Obstetrics, FIGO）Ⅲ期子宫内膜癌患者常规接受辅助治疗。本研究旨在依据患者所接受的治疗方案及危险因素，评估ⅢA至ⅡIC2期子宫内膜癌患者的总生存期（overall survival, OS）与无病生存期（disease-free survival, DFS）。
【材料与方法】2000年至2010年间接受治疗的Ⅲ期子宫内膜癌患者，从省级癌症登记数据库中筛选纳入。采用描述性分析与多变量分析方法，对比分析患者的临床病理特征、辅助治疗方案及预后结局。
【研究结果】本研究共纳入261例Ⅲ期子宫内膜癌患者，其中ⅢA期132例、ⅢB期9例、ⅡIC1期85例、ⅡIC2期35例。FIGO病理分级为1级者39例，2级者73例，3级者147例；组织学类型为子宫内膜样癌者160例，浆液性癌者35例。患者接受的辅助治疗方案分布为：161例接受序贯辅助化疗（chemotherapy, CT）与放疗（radiotherapy, RT），33例仅接受放疗，32例仅接受化疗，35例未接受任何辅助治疗。
各分期亚组的5年无病生存期（5Y-DFS）与总生存期（5Y-OS）水平相近：ⅢA期患者分别为46.7%、58.5%，ⅢB期为50.8%、58.5%，ⅡIC1期为44%、49.9%，ⅡIC2期为42%、41.6%。与未接受放疗的患者相比，接受辅助放疗者的中位无病生存期（53.7个月 vs 14.7个月，p＜0.00001）与中位总生存期（61.9个月 vs 25.7个月，p＜0.00001）均显著提升。同理，与未接受化疗的患者相比，接受辅助化疗者的中位无病生存期（54.8个月 vs 16.5个月，p＜0.00001）与中位总生存期（62.9个月 vs 26.5个月，p＜0.00001）亦显著改善。接受化疗联合放疗的患者预后更优，其5年无病生存期与总生存期分别为58.3%与65.2%，优于仅接受单一辅助治疗的患者。多变量分析结果显示，病理分级3级、深肌层浸润（浸润深度＞50%）以及未接受辅助放疗或化疗，均为导致无病生存期与总生存期不良预后的独立危险因素。
【研究结论】对于Ⅲ期子宫内膜癌患者，联合应用化疗与放疗可显著改善其无病生存期与总生存期，因此应推荐所有符合收治指征的术后患者接受该联合辅助治疗方案。