Increased survival in non-endometrioid endometrial cancer after introducing lymphadenectomy and tailoring radiotherapy-A population-based cohort study

被引:8
作者
Akesson, Asa [1 ,2 ,4 ]
Adok, Claudia [3 ]
Dahm-Kahler, Pernilla [1 ,2 ]
机构
[1] Sahlgrens Univ Hosp, Dept Obstet & Gynecol, Gothenburg, Sweden
[2] Univ Gothenburg, Inst Clin Sci, Dept Obstet & Gynecol, Sahlgrenska Acad, Gothenburg, Sweden
[3] Reg Canc Ctr Western Sweden, Gothenburg, Sweden
[4] Sahlgrens Univ Hosp, Dept Obstet & Gynecol, SE-41345 Gothenburg, Sweden
关键词
Endometrial cancer; Uterine cancer; Endometrial neoplasms; Lymph nodes; Recurrence; Lymphadenectomy; Gynecological oncology surgery; Cohort studies; Registries; ADVANCED OVARIAN-CANCER; GYNECOLOGIC-ONCOLOGY; UTERINE-CANCER; EARLY-STAGE; RISK; CARCINOMA; REGISTER; WOMEN; CHEMOTHERAPY; RECURRENCE;
D O I
10.1016/j.ejca.2022.04.002
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objective: To investigate recurrence and survival in non-endometrioid endometrial cancer in a population-based cohort and evaluate the implementation of the first national guidelines (NGEC) recommending pelvic and paraaortic lymphadenectomy for surgical staging and tailored adjuvant therapy. Methods: A population-based cohort study that used the Swedish quality registry for gynaecological cancer for the identification of all women with early-stage non-endometrioid endometrial cancer between 2010 and 2017. Five-year overall (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. The Cox proportional hazards regression model was used to evaluate the effect of age, FIGO stage, primary treatment and lymph node dissection on DFS. Results: There were 228 patients included in the study cohort and 67 (29%) patients had a recurrence within five years. In the recurrence cohort, the OS was 13.4% (95%CI:7.3-24.7) compared to 88.5% (95%CI:83.4-93.9) if no recurrence occurred (log-rank p < 0.001). The DFS for the complete cohort was 61.9% (95%CI:55.7-68.7). The OS before implementation of NGEC was 57.3% (95%CI:48.2-68.1) and the DFS was 52.1% (95%CI:43.0-63 .1) compared to an OS of 72.0% (95%CI:64.2-80 .7; log-rank p = 0.018) and a DFS of 70.1% (95%CI:62.4-78.7; log-rank p = 0.008) after implementing NGEC. Patients received adjuvant radiotherapy in 92.7% before and 42.4% after NGEC implementation (p < 0.001). In the multivariable regression analysis, age, FIGO stage and lymph node dissection were found to be significant prognostic factors, where having a lymph node
引用
收藏
页码:54 / 63
页数:10
相关论文
共 32 条
[1]   Canadian high risk endometrial cancer (CHREC) consortium: Analyzing the clinical behavior of high risk endometrial cancers [J].
Altman, Alon D. ;
Ferguson, Sarah E. ;
Atenafu, Eshetu G. ;
Koebel, Martin ;
McAlpine, Jessica N. ;
Panzarella, Tony ;
Lau, Susie ;
Gien, Lilian T. ;
Gilks, Blake ;
Clarke, Blaise ;
Cameron, Anna ;
Nelson, Gregg ;
Han, Guangming ;
Samouelian, Vanessa ;
Ho, T. C. ;
Louie, Kim ;
Bernardini, Marcus Q. .
GYNECOLOGIC ONCOLOGY, 2015, 139 (02) :268-274
[2]   The completeness of the Swedish Cancer Register - a sample survey for year 1998 [J].
Barlow, Lotti ;
Westergren, Kerstin ;
Holmberg, Lars ;
Talback, Mats .
ACTA ONCOLOGICA, 2009, 48 (01) :27-33
[3]   Sentinel lymph node mapping alone compared to more extensive lymphadenectomy in patients with uterine serous carcinoma [J].
Basaran, Derman ;
Bruce, Shaina ;
Aviki, Emeline M. ;
Mueller, Jennifer J. ;
Broach, Vance A. ;
Cadoo, Karen ;
Soslow, Robert A. ;
Alektiar, Kaled M. ;
Abu-Rustum, Nadeem R. ;
Leitao, Mario M., Jr. .
GYNECOLOGIC ONCOLOGY, 2020, 156 (01) :70-76
[4]  
Burke WM, 2014, GYNECOL ONCOL, V134, P393, DOI 10.1016/j.ygyno.2014.06.003
[5]   ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up [J].
Colombo, N. ;
Creutzberg, C. ;
Amant, F. ;
Bosse, T. ;
Gonzalez-Martin, A. ;
Ledermann, J. ;
Marth, C. ;
Nout, R. ;
Querleu, D. ;
Mirza, M. R. ;
Sessa, C. .
ANNALS OF ONCOLOGY, 2016, 27 (01) :16-41
[6]   ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma [J].
Concin, Nicole ;
Matias-Guiu, Xavier ;
Vergote, Ignace ;
Cibula, David ;
Mirza, Mansoor Raza ;
Marnitz, Simone ;
Ledermann, Jonathan ;
Bosse, Tjalling ;
Chargari, Cyrus ;
Fagotti, Anna ;
Fotopoulou, Christina ;
Gonzalez Martin, Antonio ;
Lax, Sigurd ;
Lorusso, Domenica ;
Marth, Christian ;
Morice, Philippe ;
Nout, Remi A. ;
O'Donnell, Dearbhaile ;
Querleu, Denis ;
Raspollini, Maria Rosaria ;
Sehouli, Jalid ;
Sturdza, Alina ;
Taylor, Alexandra ;
Westermann, Anneke ;
Wimberger, Pauline ;
Colombo, Nicoletta ;
Planchamp, Francois ;
Creutzberg, Carien L. .
INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, 2021, 31 (01) :12-39
[7]  
Corpus uteri, 2020, GLOBOCAN, P2020
[8]   Centralized primary care of advanced ovarian cancer improves complete cytoreduction and survival - A population-based cohort study [J].
Dahm-Kahler, Pernilla ;
Palmqvist, Charlotte ;
Staf, Christian ;
Holmberg, Erik ;
Johannesson, Liza .
GYNECOLOGIC ONCOLOGY, 2016, 142 (02) :211-216
[9]   Guideline-concordant treatment is associated with improved survival among women with non-endometrioid endometrial cancer [J].
Dholakia, Jhalak ;
Llamocca, Elyse ;
Quick, Allison ;
Salani, Ritu ;
Felix, Ashley S. .
GYNECOLOGIC ONCOLOGY, 2020, 157 (03) :716-722
[10]   Update on Sentinel Lymph Node Biopsy in Surgical Staging of Endometrial Carcinoma [J].
Eriksson, Ane Gerda Z. ;
Davidson, Ben ;
Trent, Pernille Bjerre ;
Eyjolfsdottir, Brynhildur ;
Dahl, Gunn Fallas ;
Wang, Yun ;
Staff, Anne Cathrine .
JOURNAL OF CLINICAL MEDICINE, 2021, 10 (14)