分子分类时代晚期/转移性子宫内膜癌的前期和间期减容手术

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2025-04-12 DOI:10.1016/j.ejogrb.2025.113958

Fabio Caiazzo , Francesco Raspagliesi , Valentina Chiappa , Simone Bruni , Lorenzo Ceppi , Giorgio Bogani

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引用次数: 0

摘要

目的评价不同分子亚型晚期/转移性子宫内膜癌患者接受原发性减容手术（PDS）或新辅助化疗（NACT）后间隔减容手术（IDS）的预后及影响因素。方法回顾性分析2010年9月至2024年2月期间接受手术治疗的子宫内膜癌、腹膜癌和/或“大体积”淋巴结转移患者。比较了四种分子亚型（p53突变型、mmr缺陷型、NSMP型和pole突变型）和手术方式的生存结果。结果51例IIIC-IVB期子宫内膜癌患者接受手术治疗。36例（70.5%）患者行PDS后辅助化疗，15例（29.5%）患者行NACT后辅助化疗。两组中大多数患者均为FIGO IVB期疾病：PDS组24例（66.6%），IDS组14例（93.3%）。83.3%的PDS组和40%的IDS组实现了完全的细胞减少，两组之间的术后发病率无显著差异。大多数患者的分子谱数据可用，p53突变肿瘤是最常见的亚型（PDS组为36.1%，IDS组为46.6%），其次是mmr缺陷肿瘤（PDS组为30.5%，IDS组为26.6%）。手术入路类型（PDS vs. IDS）与无病生存（p = 0.523， log-rank检验）或总生存（p = 0.123， log-rank检验）无统计学显著相关。同样，分子分类不能预测患者无病生存期（p = 0.397， log-rank检验）或总生存期（p = 0.797， log-rank检验）。结论晚期子宫内膜癌患者的预后仍较差。新辅助化疗仍然是不可切除疾病患者的可行治疗选择。考虑到组织学和分子特征，个性化的新辅助治疗方法可能会改善这类患者的生存结果。

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Upfront and interval debulking surgery in advanced/metastatic endometrial cancer in the era of molecular classification

Objective

To evaluate oncologic outcomes and prognostic factors of the different molecular subtypes of advanced/metastatic endometrial cancer treated with primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS).

Methods

We conducted a retrospective analysis of patients with endometrial cancer and peritoneal carcinomatosis and/or “bulky” nodal metastasis surgically treated between September 2010 and February 2024. Survival outcomes were compared across four molecular subtypes (p53-mutant, MMR-deficient, NSMP, and POLE-mutant) and surgical approaches.

Results

Overall, 51 patients with stage IIIC-IVB endometrial cancer underwent surgical treatment. Thirty-six (70.5 %) patients had PDS followed by adjuvant chemotherapy, while fifteen (29.5 %) received NACT followed by IDS. Most patients in both groups had FIGO stage IVB disease: 24 (66.6 %) in the PDS group and 14 (93.3 %) in the IDS group. Complete cytoreduction was achieved in 83.3 % of the PDS group and 40 % of the IDS group, with no significant differences in postoperative morbidity between the groups. Molecular profiling data were available for most patients, with p53-mutated tumors being the most common subtype (36.1 % in the PDS group and 46.6 % in the IDS group), followed by MMR-deficient tumors (30.5 % in the PDS group and 26.6 % in the IDS group). The type of surgical approach (PDS vs. IDS) did not show a statistically significant correlation with disease-free survival (p = 0.523, log-rank test) or overall survival (p = 0.123, log-rank test). Similarly, molecular classification did not predict patient outcomes in terms of disease-free survival (p = 0.397, log-rank test) or overall survival (p = 0.797, log-rank test).

Conclusions

Oncologic outcomes for patients with advanced endometrial cancer remain poor. Neoadjuvant chemotherapy continues to be a viable treatment option for patients with unresectable disease. A personalized approach to neoadjuvant therapy, taking into account histologic and molecular profiles, may improve survival outcomes in this patient population.

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.