Treatment for low-grade and high-grade endometrial carcinoma after recurrence/relapse before the molecular targeted therapy era: A retrospective, propensity score-matched cohort study
Masao Okadome, Kenzo Sonoda, Rina Nagayama, Toshiaki Saito, Kumi Shimamoto, Ai Nio, Yu Yoshida, Ayano Tsubomi, Shinichiro Yamaguchi, Kazuya Ariyoshi
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引用次数: 0
Abstract
Aim
To compare the prognosis of low-grade endometrial carcinoma (LG-EC) with that of high-grade endometrial carcinoma (HG-EC) after first recurrence/relapse before the molecular targeted therapy era.
Methods
Recurrent/relapsed endometrial cancer was diagnosed in 155 women at our hospital between January 26, 1999 and February 26, 2019. Fifty of these women received paclitaxel–carboplatin, two received doxorubicin–cisplatin, and one received docetaxel–carboplatin as postoperative chemotherapy. Two women who did not receive postoperative chemotherapy received paclitaxel–carboplatin for their first recurrence/relapse. The prognosis in these 55 women was retrospectively investigated using propensity score matching.
Results
Twenty-five women had LG-EC and 30 had HG-EC. Cox proportional hazards analysis identified response to chemotherapy for the first recurrence/relapse to be a statistically significant determinant of progression-free survival and HG-EC to be a significant determinant of overall survival. After propensity score matching, median overall survival was better in women with LG-EC than in those with HG-EC (82 months [95% CI 27–not reached] vs. 31 months [95% CI 2–47], p = 0.0127). Three women survived for at least 10 years without recurrence after completion of treatment. The interval between postoperative chemotherapy and first recurrence was more than 6 months. The recurrences resolved after multimodal treatment or aggressive chemotherapy followed by 5–12 cycles of chemotherapy other than paclitaxel–carboplatin if received postoperatively.
Conclusions
The prognosis was poorer in patients with recurrent/relapsed HG-EC than in those with recurrent/relapsed LG-EC before the molecular targeted therapy era. There were no long-term recurrence-free survivors after repeat paclitaxel–carboplatin chemotherapy.
目的:比较分子靶向治疗时代前低级别子宫内膜癌(LG-EC)与高级别子宫内膜癌(HG-EC)首次复发/复发后的预后。方法:1999年1月26日至2019年2月26日在我院诊断为复发/复发子宫内膜癌的155例妇女。其中50名妇女接受了紫杉醇-卡铂,2名接受了阿霉素-顺铂,1名接受了多西他赛-卡铂作为术后化疗。两名未接受术后化疗的妇女首次复发时接受了紫杉醇-卡铂治疗。采用倾向评分匹配法对这55名妇女的预后进行回顾性调查。结果:25例女性有LG-EC, 30例女性有HG-EC。Cox比例风险分析发现,首次复发/复发对化疗的反应是无进展生存期的统计学显著决定因素,HG-EC是总生存期的显著决定因素。倾向评分匹配后,LG-EC患者的中位总生存期优于HG-EC患者(82个月[95% CI 27-未达到]vs. 31个月[95% CI 2-47], p = 0.0127)。3名妇女在完成治疗后存活了至少10年没有复发。术后化疗至首次复发间隔6个月以上。多模式治疗或积极化疗后,如果术后接受紫杉醇-卡铂以外的化疗5-12周期,复发消失。结论:分子靶向治疗时代之前,HG-EC复发/复发患者的预后较LG-EC复发/复发患者差。重复紫杉醇-卡铂化疗后没有长期无复发幸存者。
期刊介绍:
The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology.
The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.