Retrospective Analysis Of Clinical Efficacy And Prognostic Factors Of Adjuvant Treatment For High-Risk Early Stage Endometrial Carcinoma

Objective:To analyze the efficacy and prognostic factors of adjuvant therapy for patients of stage I high-risk endometrial adenocarcinoma after surgery,and to provide clinical basis for treatment choiceMethods:A retrospective analysis was performed on 97 patients of endometrial adenocarcinoma with high-risk factors treated in our hospital from 2010 to 2014.59 patients received adjuvant postoperative treatment is defined as the treatment group 22 patients received radiotherapy alone which used External pelvic radiation or brachytherapy,the total dose is goes to 45Gy～50Gy or 30Gy;37 patients received chemoradiotherapy,radiotherapy method is the same as before,the chemotherapy regimen is paclitaxel and platinum,dose is goes to paclitaxel 135～175mg/m2,cisplatin 75mg/m2 or carboplatin with AUC=5,all the medicine were given by intravenous drip,repeated every 21 days,2-3 cycles.38 patients were observed after operation defined as observation group.The main observation indicators were rate of 5-year survival(5-OS)and rate of 5-year disease-free survival(5-DFS).The secondary observation indicators were treatment-related side effects,and the correlation between clinical-pathological indicators and prognosis.Follow-up was conducted through hospital inpatient system,outpatient service,telephone,and public security household registration system.All data were analyzed by SPSS 22.0 statistical analysis system,Kaplan-Meier method was used to calculate the survival rate,Log-rank method was used for univariate analysis,Cox proportional hazard model was used for multivariate analysis,and x2 was used to test the effects of different treatment methods on adverse reactions.The ROC curve determines the optimal cut-off value for hematological parameters to assess the predictive prognosis and correlation with clinical characteristics.Prognostic Nomogram model was constructed based on independent risk factors determined by survival analysis.The consistency index(C-index)and calibration curve(CC)was used to evaluate its accuracyResults:The 5-OS of the treatment group and the observation group were 96.6%and 81.4%,respectively.The difference was statistically significant(P=0.010),and the 5-DFS was 89.1%and 70.9%,respectively.The difference was statistically significant(P=0.020).Further subgroup analysis was performed on the treatment group.The 5-OS of the group of radiotherapy alone and the combined chemoradiotherapy group were 100%and 94.6%,respectively,with no significant difference(P=0.272).The 5-DFS was 92.9%and 86.5%,respectively.The difference was not statistically significant(P=0.272).In terms of treatment-related side effects:11 cases of bone marrow suppression(50.0%)in the radiotherapy alone group and 32 cases(86.5%)in the combined chemoradiotherapy group,the difference was statistically significant(P=0.000).Histologic grade,lymph-vascular space invasion(LVSI),deep myometrial invasion,adjuvant therapy,and neutrophils to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),and lymphocyte to monocyte ratio(LMR)affected tumor recurrence and overall survival in early stage high-risk endometrial carcinoma patients.(P<0.05).Histologic grade,LVSI,and adjuvant therapy were independent prognostic factor for OS and DFS.The C-index of newly constructed OS-Nomogram prediction model was 0.816,the 3-and 6-year calibration curves showed a good agreement between predicted overall survival,The C-index of DFS-Nomogram prediction model was 0.786,and the 3-,6-and 9-year calibration curves showed a good agreement between predicted disease-free survival.Conclusion:Adjuvant postoperative adjuvant therapy for early stage high-risk EC patients can reduce recurrence and metastasis,prolong overall survival.Meanwhile,compared with radiotherapy alone,chemoradiotherapy has not shown any advantage in overall survival or disease-free survival,even significantly increased the incidence of bone marrow suppression.Histologic grade,LVSI,deep myometrial invasion,postoperative adjuvant therapy,NLR,PLR,and LMR affected OS and DFS Histologic grade,LVSI and deep myometrial invasion are independent risk factors for OS and DFS.The Nomogram prediction model drawn in this study has a high prognostic value and can individually predict the rate of overall survival and disease-free survival of stage Ⅰ high-risk EC patients after surgery,which is helpful for clinical treatment decision-making and clinical research options.