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Abstract：
Background: Serous endometrial carcinoma (SEC) is a high-risk subtype of endometrial cancer. The effectiveness of multiple adjuvant therapies, namely chemotherapy (CT), radiotherapy (RT), and sequential/concurrent chemotherapy with radiotherapy (CRT), have previously been investigated. However, optimal management of early-stage SEC remains unclarified. Methods: All cases of early-stage SEC (FIGO 2009 stages I-II) treated in our institution from 2002 to 2019 were identified. Patient data were documented until September 2023. Overall survival (OS) and disease-free survival (DFS) were computed using Kaplan-Meier estimates and Cox\'s proportional hazard model; descriptive statistical analysis was performed. Results: A total of 50 patients underwent total hysterectomy-bilateral salpingo-oophorectomy and omentectomy, displaying stage IA (60%), IB (24%), and II (16%) disease. The median follow-up was 90.9 months. Patients underwent adjuvant CRT (n = 36, 72%), CT (n = 6, 12%), or RT (n = 6, 12%). Two patients were observed and excluded from analyses. The 42 patients who received radiotherapy had pelvic external beam radiotherapy (n = 10), vaginal brachytherapy (n = 21), or both (n = 11). CRT had better OS (HR 0.14, 95%CI 0.04-0.52, p < 0.005) and DFS (HR 0.25, 95%CI 0.07-0.97, p = 0.05) than CT alone. RT displayed no OS or DFS benefits compared to CT/CRT. Recurrences were mostly distant. Acute and late G3-4 toxicities were primarily hematologic. Conclusions: Our data underline the challenge of treating SEC. CRT appears to be superior to CT alone but not to RT. Most recurrences were distant, highlighting the need for optimized systemic treatment options.
摘要：
背景：浆液性子宫内膜癌（SEC）是子宫内膜癌的高危亚型。多重辅助疗法的有效性，即化疗（CT），放射治疗（RT），和序贯/同步化疗加放疗（CRT），此前曾被调查过。然而,早期SEC的优化管理仍不清楚。方法：确定2002年至2019年在我们机构治疗的所有早期SEC（FIGO2009I-II期）病例。患者数据一直记录到2023年9月。使用Kaplan-Meier估计和Cox的比例风险模型计算总生存期（OS）和无病生存期（DFS）；进行描述性统计分析。结果：共有50例患者接受了全子宫切除术-双侧附件卵巢切除术和网膜切除术，显示阶段IA(60%)，IB（24%），和II（16％）疾病。中位随访时间为90.9个月。患者接受辅助CRT（n=36，72%），CT(n=6,12%),或RT（n=6，12%）。观察到两名患者并排除在分析之外。接受放疗的42例患者行骨盆外照射（n=10），阴道近距离放射治疗（n=21），或两者（n=11）。与单独使用CT相比，CRT具有更好的OS（HR0.14，95CI0.04-0.52，p<0.005）和DFS（HR0.25，95CI0.07-0.97，p=0.05）。与CT/CRT相比，RT没有显示操作系统或DFS优势。复发大多是遥不可及的。急性和晚期G3-4毒性主要是血液学的。结论：我们的数据强调了治疗SEC的挑战。CRT似乎优于单独的CT，但不优于RT。大多数复发是遥远的，强调需要优化系统治疗方案。
