Background

Uterine carcinosarcoma (UCS) confers a high recurrence risk following surgery, and adjuvant chemotherapy (CHT) is typically administered in all stages. The benefit of radiation therapy (RT) in UCS, when added to adjuvant CHT, is unknown. We sought to analyze the Surveillance, Epidemiology, and End Results (SEER) database to ascertain whether RT improves overall survival (OS) when added to surgery and CHT for UCS.

Methods

SEER 18 Custom Data registries (Nov 2018 submission) were queried for uterine (ICD10 C54.1-9, C55.9) carcinosarcoma (ICD-0-3 8980-3). Patients with stage I-III UCS who underwent surgery and CHT ± RT were analyzed with univariate analysis (UVA) and multivariable analysis (MVA) using Kaplan–Meier and Cox proportional hazards regression modeling. Propensity-score matched analysis with inverse probability of treatment weighting (IPTW) was performed to account for indication bias. Furthermore, conditional landmark analysis (minimum three-month follow-up) was performed to minimize immortal time bias.

Results

All 1541 patients (1988–2016) underwent surgery and CHT and 54% received RT. On UVA, RT improved median and 5-year OS from 41 to 87 months and 43–55%, respectively (HR 0.65, 95% CI 0.56–0.77) (p < 0.001). After IPTW adjustment, RT improved median and 5-year OS from 46 to 65 months and 46–53%, respectively (HR 0.74, 95% CI 0.63–0.87) (p < 0.001). The benefit of RT remained on unadjusted and adjusted MVA and conditional landmark analysis.

Conclusion

In stage I–III UCS treated with surgery and CHT, receipt of RT is associated with OS benefit. Further prospective data are needed to investigate the RT’s benefit in UCS.

中文翻译：

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在子宫癌肉瘤的手术和化疗中加入辅助放疗可提高总生存率：一项监测、流行病学和最终结果分析

背景

子宫癌肉瘤 (UCS) 在手术后具有很高的复发风险，辅助化疗 (CHT) 通常在所有阶段进行。尚不清楚放疗 (RT) 在 UCS 中加入辅助 CHT 时的益处。我们试图分析监测、流行病学和最终结果 (SEER) 数据库，以确定在 UCS 的手术和 CHT 中加入放疗是否能提高总生存率 (OS)。

方法

SEER 18 自定义数据注册（2018 年 11 月提交）查询了子宫（ICD10 C54.1-9、C55.9）癌肉瘤（ICD-0-3 8980-3）。使用 Kaplan-Meier 和 Cox 比例风险回归模型对接受手术和 CHT ± RT 的 I-III 期 UCS 患者进行单变量分析 (UVA) 和多变量分析 (MVA) 分析。使用治疗加权的逆概率 (IPTW) 进行倾向评分匹配分析以解释适应症偏倚。此外，进行了有条件的地标分析（至少三个月的随访）以最大限度地减少不朽的时间偏差。

结果

所有 1541 名患者（1988-2016 年）都接受了手术和 CHT，54% 接受了放疗。在 UVA 中，RT 将中位 OS 和 5 年 OS 分别从 41 个月提高到 87 个月和 43-55%（HR 0.65，95% CI 0.56-0.77）（p  < 0.001）。调整 IPTW 后，RT 将中位 OS 和 5 年 OS 分别从 46 个月提高到 65 个月和 46-53%（HR 0.74，95% CI 0.63-0.87）（p  < 0.001）。RT 的好处仍然是未调整和调整的 MVA 和有条件的标志性分析。

结论

在接受手术和 CHT 治疗的 I-III 期 UCS 中，接受放疗与 OS 获益相关。需要进一步的前瞻性数据来研究 RT 在 UCS 中的益处。