手术及分子分型对IV期子宫内膜癌的影响。

IF 4.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Matteo Loverro, Emanuele Perrone, Vincenzo Tarantino, Giovanni Esposito, Camilla Culcasi, Fulvia Pirrelli, Raffaella Sardo Infirri, Eleonora Palluzzi, Virginia Vargiu, Veronica Celli, Francesco Fanfani
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引用次数: 0

摘要

目的:支持手术在晚期子宫内膜癌新辅助化疗后的作用的证据仍然有限。此外,在这种情况下,分子分类与预后的相关性还不明确。我们的目的是评估腹膜和/或腹外扩散患者的总生存率,重点关注手术入路和分子亚型。方法:回顾性分析2012年1月至2023年9月期间接受治疗的所有fsamdacei期IVB (fsamdacei期IIIB2, IVB, IVC)子宫内膜癌患者。根据基于免疫组织化学的分子分类、腹内疾病扩展和治疗策略对患者进行分层。Kaplan-Meier和Cox回归分析评估总生存率。使用适当的非参数和分类统计检验评估各组间的差异。结果:在363例符合条件的患者中,229例(63.1%)接受了原发性细胞减少,52例(14.3%)接受了间歇减容手术,55例(15.2%)接受了化疗,27例(7.4%)未接受治疗。接受新辅助或单独化疗的患者更频繁地出现腹外(p < 0.001)和上腹部疾病(p < 0.001)。对于盆腔外疾病患者,初次手术和间歇手术的总生存率相当(p = 0.82)。在接受新辅助治疗的患者中,手术细胞减少与总生存率的提高密切相关(p < 0.001)。错配修复缺陷患者的总生存期优于p53异常肿瘤患者(34个月vs 21个月,p = 0.026)。无特异性分子谱雌激素受体阳性肿瘤的总生存期长于p53异常亚型和无特异性分子谱雌激素受体阴性亚型(60个月vs 34个月和21个月,p = 0.018和p = 0.041)。在多因素分析中,盆腔外疾病(p = 0.042)和单纯化疗(p < 0.0001)是独立的不良预后因素。结论:在晚期子宫内膜癌中,手术仍然是治疗的关键组成部分。我们的研究结果表明,与单纯化疗相比,接受手术治疗的患者——无论是作为主要治疗还是在新辅助化疗之后——有潜在的生存优势。分子分类即使在IV期疾病中也可能提供预后,尽管需要进一步验证。这些发现为未来不断发展的免疫治疗和个性化治疗的研究提供了一个基准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of surgery and molecular classification in stage IV endometrial cancer.

Objective: Evidence supporting the role of surgery after neoadjuvant chemotherapy in advanced endometrial cancer remains limited. Additionally, the prognostic relevance of molecular classification in this setting is poorly defined. We aimed to evaluate overall survival in patients with peritoneal and/or extra-abdominal spread, focusing on surgical approach and molecular sub-type.

Methods: We retrospectively analyzed all patients with Fédération Internationale de Gynécologie et d'Obstétrique 2009 stage IVB (Fédération Internationale de Gynécologie et d'Obstétrique 2023 IIIB2, IVB, IVC) endometrial cancer treated between January 2012 and September 2023. Patients were stratified according to immunohistochemistry-based molecular classification, intra-abdominal disease extension, and treatment strategy. Kaplan-Meier and Cox regression analyses were used to assess overall survival. Differences across groups were evaluated using appropriate nonparametric and categorical statistical tests.

Results: Among 363 eligible patients, 229 (63.1%) underwent primary cytoreduction, 52 (14.3%) had interval debulking surgery, 55 (15.2%) received chemotherapy alone, and 27 (7.4%) were untreated. Patients receiving neoadjuvant or exclusive chemotherapy more frequently had extra-abdominal (p < .001) and upper abdominal disease (p < .001). In patients with extra-pelvic disease, overall survival was comparable between primary and interval surgery (p = .82). Among those treated with neoadjuvant treatment, surgical cytoreduction was strongly associated with improved overall survival (p < .001). Mismatch repair-deficient patients had better overall survival than those with p53 abnormal tumors (34 vs 21 months, p = .026). No specific molecular profile-estrogen receptor positive tumors showed longer overall survival than both p53 abnormal and no specific molecular profile-estrogen receptor negative sub-types (60 vs 34 and 21 months, p = .018 and p = .041, respectively). In multivariate analysis, extra-pelvic disease (p = .042) and exclusive chemotherapy (p < .0001) were independent negative prognostic factors.

Conclusions: In advanced endometrial cancer, surgery remains a key component of management. Our findings suggest a potential survival advantage for patients who undergo surgery-either as primary treatment or following neoadjuvant chemotherapy-compared to those treated with chemotherapy alone. Molecular classification may offer prognostic insight even in stage IV disease, although further validation is required. These findings provide a benchmark for future studies in the evolving landscape of immunotherapy and personalized treatment.

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来源期刊
CiteScore
6.60
自引率
10.40%
发文量
280
审稿时长
3-6 weeks
期刊介绍: The International Journal of Gynecological Cancer, the official journal of the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology, is the primary educational and informational publication for topics relevant to detection, prevention, diagnosis, and treatment of gynecologic malignancies. IJGC emphasizes a multidisciplinary approach, and includes original research, reviews, and video articles. The audience consists of gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, and research scientists with a special interest in gynecological oncology.
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