子宫癌根据2023年FIGO指南的最新重新恢复并不统一影响预后：一项机构回顾性队列研究
Uterine cancer restaging according to the updated 2023 FIGO Guidelines does not uniformly affect prognosis: An institutional retrospective cohort study
影响因子:4.10000
分区:医学2区 Top / 妇产科学1区 肿瘤学2区
发表日期:2024 Oct
作者:
R N Senguttuvan, N Lugo-Santiago, B Nakamura, M Song, E Han, N Ruel, D Cook, K Robinson, A Kohut, J G Cohen
摘要
鉴于子宫内膜癌发生率升高（EC），已努力使患者更好地分层。现在，2023 FIGO分期将组织学亚型和分子分类纳入EC阶段的确定。我们试图阐明与2009年分阶段系统相比，新的分期系统是否表现出预后差异。从2013年9月至2023年5月，对我们机构治疗的EC治疗的妇女进行了回顾性图表审查，并结合了公开可用的TCGA自然2013年数据集。捕获了详细的临床信息。根据2023年的指南重新恢复患者。使用Kaplan-Meier方法获得了存活率估计，并使用对数秩检验比较无进展生存期的存活曲线（PFS）。919患者包括在我们的分析中。这些数据集关于诊断时的组织学等级，阶段和年龄是可比的。该机构数据集中的175例（31.5％）和TCGA数据集中的115例（31.6％）患者经历了阶段变化。大多数阶段变化的患者是升级的（275/290； 94.8％）。与上升阶段的IA期患者的3年PFS估计值为92.3％（95％CI：87.2，95.4）v。72.0％（95％CI：68.4，84.9），p = 0.002。在其他阶段子集中没有观察到生存差异的显着差异。在EC的患者中，最初是接受升级的IA的患者中存在了最新的生存差异。在重新安排到II或III期子集的患者中未观察到显着的生存差异。在评估子宫内膜癌患者的预后和辅助治疗时，需要改善风险分层。
Abstract
Efforts have been made to better risk stratify patients given the rise in incidence of endometrial cancer (EC). The 2023 FIGO staging now incorporates histologic subtype and molecular classification into determination of EC stage. We sought to elucidate if the new staging system demonstrated prognostic differences compared to the 2009 staging system.A retrospective chart review was performed on women treated for EC at our institution from September 2013 to May 2023 and combined with the publicly available TCGA Nature 2013 dataset. Detailed clinical information was captured. Patients were restaged according to the 2023 guidelines. Survival estimates were obtained using Kaplan-Meier method, and the log-rank test was used to compare survival curves for progression-free survival (PFS).919 patients were included in our analysis. The datasets were comparable regarding histologic grade, stage, and age at diagnosis. 175 (31.5%) of patients in the institution dataset and 115 (31.6%) patients in the TCGA dataset experienced a stage change. Most patients whose stage changed were upstaged (275/290; 94.8%). 3-year PFS estimates for stage IA patients with no stage change versus those upstaged were 92.3% (95% CI: 87.2, 95.4) v. 72.0% (95% CI: 68.4, 84.9), p = 0.002. No significant differences in survival difference were seen in other stage subsets.Modest survival differences exist in patients with EC originally staged as IA who underwent upstaging. No significant survival difference is observed in patients who are restaged to stage II or III subsets. Improved risk stratification is needed in assessing prognosis and adjuvant therapy for patients with endometrial cancer.