29 Low-grade endometrioid endometrial cancer with adnexal metastasis: possible de-escalation candidate for adjuvant therapy?
Notice bibliographique
Résumé
According to the National Comprehensive Cancer Network clinical practice guidelines, patients with stage III endometrioid endometrial cancer are recommended to receive combination therapy with systemic chemotherapy and external beam radiotherapy. Mounting translational data proposed a concept of “restricted microenvironmental compatibility” in low-grade endometrioid endometrial cancer. In this theory, low-grade endometrioid tumors are indolent and further distant metastasis beyond the ovary is biologically limited. We hypothesized that this tumor group has good oncologic outcomes even after metastasis to the ovary. The objective of current study was to examine the association between adjuvant therapy and oncologic outcomes of patients with low-grade endometrioid endometrial cancer with metastasis to the adnexa. We retrospectively queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The study population was stage IIIA grade 1–2 endometrioid endometrial cancer with ovarian or tubal metastasis only who received adjuvant therapy from 2010–2015. Patients with uterine serosal disease, nodal involvement, distant metastasis, and secondary primary cancer were excluded. The exposure was adjuvant therapy, grouped as systemic chemotherapy without external beam radiotherapy (EBRT), EBRT alone, and combination of the two. The outcome measure was endometrial cancer-specific survival. Cox proportional hazard regression model was fitted to assess the exposure-outcome association, adjusting for patient age and tumor differentiation. A total of 245 patients were evaluated. The most frequent adjuvant therapy was systemic chemotherapy alone (46.1%), followed by combination of systemic chemotherapy and EBRT (42.0%) and EBRT alone (11.8%). The median follow-up was 6.4 (IQR 5–7.8) years. The 5-year endometrial cancer-specific survival rates were 93.3% for systemic chemotherapy alone, 92.9% for EBRT alone, and 91.0% for combination therapy (P=0.963). After controlling for patient age and tumor differentiation, combination therapy (adjusted-hazard ratio 0.83, 95% confidence interval 0.36–1.89) and EBRT alone (adjusted-hazard ratio 0.86, 95% confidence interval 0.24–3.15) were not associated with endometrial cancer-specific mortality compared to systemic chemotherapy alone. This association remained robust in sensitivity analyses for grade 1 (5-year endometrial cancer-specific survival rates for systemic chemotherapy alone, EBRT alone, and both: 95.9%, 100%, and 94.9%, respectively, P=0.618) and grade 2 (91.1%, 84.6%, and 88.6%, respectively, P=0.725) lesions. Download : Download high-res image (68KB)Download : Download full-size image These results suggest that patients with low-grade endometrioid endometrial cancer with metastases to the adnexa alone have a favorable prognosis. In this cohort combination therapy may not improve oncologic outcome compared to systemic chemotherapy alone.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».