Adjuvant radiotherapy outcomes and prognostic factors in FIGO 2023 stage IIC endometrial cancer: One sea, different depths

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-06-17 DOI:10.1016/j.ygyno.2025.06.007

Alper Kahvecioglu , Melis Gultekin , Ecem Yigit , Sezin Yuce Sari , Alp Usubutun , Deniz Ates Ozdemir , Zafer Arik , Murat Gultekin , Ferah Yildiz

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引用次数: 0

Abstract

Objective

FIGO 2023 Stage IIC endometrial cancer (EC) comprises a heterogeneous group of uterine-confined, myoinvasive tumors with aggressive histological subtypes. This study aimed to evaluate treatment outcomes and identify prognostic factors in patients treated with adjuvant radiotherapy (RT), with or without chemotherapy (CTX).

Methods

A retrospective evaluation was conducted on 1297 EC patients treated with adjuvant RT following surgical staging between 1994 and 2023. Among these, 229 patients met the FIGO 2023 Stage IIC criteria and were included in this study.

Results

The cohort included 59 % high-grade endometrioid and 41 % non-endometrioid EC. Vaginal brachytherapy was the primary RT modality (63 %), with 38 % receiving combined CTX and RT. Over a median follow-up of 64.5 months, recurrences occurred in 14 %, primarily as distant metastases (DM), while locoregional control (LRC) was 95 %. Five-year overall survival (OS) and progression-free survival (PFS) rates were 88 % and 82 %, respectively. Advanced age (≥ 60 years) predicted worse OS (HR: 5.9, p < 0.001) and PFS (HR: 7.1, p < 0.001), and endocervical stromal invasion was independently associated with worse PFS (HR: 2.79, p = 0.003). CTX improved OS and PFS in non-endometrioid tumors but showed no benefit in high-grade endometrioid cancer.

Conclusions

Although FIGO 2023 Stage IIC EC shows diverse outcomes, adjuvant RT provides excellent LRC, while DM remain challenging. Endocervical stromal invasion remains a key prognostic factor, predicting poorer PFS, while CTX shows benefit exclusively in non-endometrioid tumors. These findings emphasize the critical need for personalized risk-grouping and adjuvant treatment strategies.

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FIGO 2023期IIC期子宫内膜癌的辅助放疗效果及预后因素：一海，不同深度

IIC期子宫内膜癌（EC）包括一组具有侵袭性组织学亚型的子宫受限、肌侵袭性肿瘤。本研究旨在评估辅助放疗（RT）伴化疗或不伴化疗（CTX）患者的治疗结果并确定预后因素。方法回顾性分析1994 ~ 2023年1297例经手术分期后行辅助放疗的EC患者的临床资料。其中229例患者符合FIGO 2023 IIC期标准，纳入本研究。结果该队列包括59%的高级别子宫内膜样癌和41%的非子宫内膜样癌。阴道近距离放疗是主要的放疗方式（63%），38%的患者接受CTX和RT联合治疗。在64.5个月的中位随访中，14%的患者复发，主要是远处转移（DM），而局部区域对照（LRC）为95%。5年总生存率（OS）和无进展生存率（PFS）分别为88%和82%。高龄（≥60岁）预测更差的OS (HR: 5.9, p <；0.001)和PFS (HR: 7.1, p <；0.001)，宫颈间质浸润与PFS恶化独立相关（HR: 2.79, p = 0.003）。CTX改善了非子宫内膜样肿瘤的OS和PFS，但对高级别子宫内膜样癌没有效果。尽管FIGO 2023期IIC期EC显示出不同的结果，但辅助RT提供了良好的LRC，而DM仍然具有挑战性。宫颈间质浸润仍然是一个关键的预后因素，预测较差的PFS，而CTX仅对非子宫内膜样肿瘤有益。这些发现强调了个性化风险分组和辅助治疗策略的必要性。

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