Adjuvant treatment in stage I clear cell endometrial carcinoma: A population-based study of survival outcomes

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-04-03 DOI:10.1016/j.ygyno.2025.03.051

Alyssa C Bujnak , Danielle Greenberg , Jenny Chang , Jill Tseng

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Abstract

Objective

Uterine clear cell carcinoma (UCCC) is a rare but aggressive histologic type of endometrial cancer. Recommendations for adjuvant treatment of early-stage UCCC remain vague. The objective of this study is to assess the impact of adjuvant treatment on survival outcomes of patients with stage I UCCC.

Methods

Using the Surveillance, Epidemiology and End Results database (SEER), patients with stage I UCCC were identified. Disease-specific survival (DSS) as well as overall survival (OS) for patients who underwent observation alone versus adjuvant treatment with either chemotherapy alone, radiotherapy (RT) alone, or chemotherapy plus RT, were analyzed by Kaplan-Meier (K-M) survival estimates and multivariate Cox proportion hazards model.

Results

The study included 881 patients with stage I UCCC. Kaplan-Meier estimates showed no difference in DSS among those who underwent observation versus adjuvant treatment. In the multivariate model for DSS, tumor size ≥40 mm was associated with an increased risk of death (HR 2.02, p = 0.0267) while living in a metropolitan county decreased the risk of death (HR 0.46, p = 0.009). The K-M curve for OS showed a significant difference among the four treatment groups (p = 0.0475), with a 10-year OS of 61 % for patients who received no adjuvant treatment versus 74 % for those receiving chemotherapy plus radiation. However, this difference was not significant in the multivariate analysis.

Conclusions

In this study of stage I UCCC, the use of adjuvant treatment did not confer a survival advantage. Observation may be considered an acceptable option although prospective research is needed.

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I期透明细胞子宫内膜癌的辅助治疗：一项基于人群的生存结果研究

目的子宫透明细胞癌（UCCC）是一种罕见的侵袭性子宫内膜癌。早期UCCC辅助治疗的建议仍然不明确。本研究的目的是评估辅助治疗对I期UCCC患者生存结局的影响。方法使用监测、流行病学和最终结果数据库（SEER）对I期UCCC患者进行鉴定。通过Kaplan-Meier （K-M）生存估计和多变量Cox比例风险模型分析单独观察与辅助治疗（单独化疗、单独放疗或化疗加放疗）的患者的疾病特异性生存（DSS）和总生存（OS）。结果本研究纳入881例I期UCCC患者。Kaplan-Meier估计显示，在接受观察治疗和辅助治疗的患者中，DSS没有差异。在DSS的多变量模型中，肿瘤大小≥40 mm与死亡风险增加相关（HR 2.02, p = 0.0267），而居住在大都市县会降低死亡风险（HR 0.46, p = 0.009）。4个治疗组的OS K-M曲线显示出显著差异（p = 0.0475），未接受辅助治疗的患者10年OS为61%，而接受化疗加放疗的患者10年OS为74%。然而，在多变量分析中，这种差异并不显著。结论：在这项I期UCCC的研究中，使用辅助治疗并没有带来生存优势。虽然需要前瞻性研究，但观察可以被认为是一种可接受的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy