Características clínicas e desfechos de uma coorte de câncer endometrial de alto grau tratada no Instituto Nacional de Câncer, Brasil

Paulino, Eduardo; Melo, Andreia Cristina de

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Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Brasil

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Sumário

Original Article • Rev Bras Ginecol Obstet 45 (7) • 2023 • https://doi.org/10.1055/s-0043-1772177 copiar

Características clínicas e desfechos de uma coorte de câncer endometrial de alto grau tratada no Instituto Nacional de Câncer, Brasil

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

Analisar os desfechos de uma coorte de pacientes com câncer de endométrio (CE) e histologias de alto risco atendida no Instituto Nacional do Câncer (INCA) entre 2010 e 2016.

Materiais e Métodos

Foram revisados prontuários de pacientes com histologias de alto risco de CE em qualquer estágio cadastradas no INCA entre 2010 e 2016 para realizar uma análise descritiva clínica e demográfica e avaliar os resultados em termos de recorrência e sobrevida.

Resultados

De 2010 a 2016, 2.145 pacientes com CE foram cadastradas e atendidas no INCA, e 466 tinham histologias de alto grau e atendiam aos critérios de inclusão. A média de idade das pacientes foi de 65 anos, 44,6% eram brancas, e 90% tinham performance status de 0 ou 1. A histologia mais comum foi endometrioide de alto grau (31,1%), seguida de carcinoma seroso (25,3%), misto (20,0%), carcinossarcoma (13,5%) e carcinoma de células claras (9,4%). Considerando o estadiamento da Fédération Internationale de Gynécologie et d'Obstétrique (Federação Internacional de Ginecologia e Obstetrícia, FIGO, em francês) de 2018, 44,8%, 12,4%, 29,8% e 12,9% apresentaram estágios I, II, III ou IV, respectivamente. Idade (> 60 anos), mais de 50% de mioinvasão, estágio avançado, performance status ruim, histologias serosas e carcinossarcoma, e tratamento adjuvante foram fatores independentes associados à sobrevida livre de recorrência e sobrevida global na análise multivariada.

Conclusão

Os achados atuais reforçam os dados internacionais que demonstram o prognóstico ruim desses tumores, principalmente para as histologias serosas e carcinossarcomas e para estágios avançados, com menor sobrevida e altas taxas de recorrência à distância, independentemente do estágio da FIGO. A terapia adjuvante foi associada a melhor sobrevida.

Palavras-chave
câncer de endométrio; terapia para câncer de endométrio; patologia câncer de endométrio; análise demográfica

Variables		n (%); N =466
Age	Mean (± standard deviation)	65.9 (11.5) years
Age group	< 60	118 (25.3) years
	≥ 60	348 (74.7) years
Race	White	208 (44.6)
	Black	89 (19.1)
	Non-white/black	169 (36.3)
Histological subtype	AEG3	145 (31.1)
	USC	118 (25.3)
	CCC	44 (9.4)
	CCS	63 (13.5)
	Mixed	93 (20.0)
	NOS	3 (0.6)
Type of surgery	TAH	14 (3.0)
	TAH + BSO	132 (28.4)
	TAH + BSO + LFN (PLNs or PALNs)	157 (33.8)
	TAH + BSO + LFN + omentectomy	162 (34.8)
Route of surgery	Open	420 (90.3)
	Laparoscopic	25 (5.4)
	Transvaginal	12 (2.6)
	Robotic	8 (1.7)
ECOG-PS	0	116 (25.3)
	1	297 (64.8)
	2	33 (7.2)
	3	12 (2.6)
2018 FIGO	IA	148 (31.8)
	IB	61 (13.1)
	II	58 (12.4)
	IIIA	35 (7.5)
	IIIB	6 (1.3)
	IIIC1	63 (13.5)
	IIIC2	35 (7.5)
	IVA	2 (0.4)
	IVB	58 (12.4)
2018 FIGO	I	209 (44.8)
	II	58 (12.4)
	III	139 (29.8)
	IV	60 (12.9)
Myoinvasion	No invasion	24 (5.2)
	Less than 50%	214 (46.0)
	More than 50%	227 (48.8)
Chemotherapy	No	231 (49.6)
	Yes	235 (50.4)
Type of chemotherapy	Adjuvant	225 (95.7)
	Neoadjuvant	10 (4.3)
Cycles of chemotherapy	Mean (± standard deviation)	5.7 (1.1)
Adjuvant radiotherapy	No	313 (67.3)
	Yes	152 (32.7)
Radiotherapy dose (cGY)	Mean (± standard deviation)	4,800 (2,600)
Adjuvant brachytherapy	No	326 (70.1)
	Yes	139 (29.9)
Brachytherapy dose (cGY)	Mean (± standard deviation)	2,675.4 (350.6)
Any type of treatment^a Note: ᵃIncludes chemotherapy and/or radiotherapy and/or brachytherapy.	No	104 (22.4)
	Yes	361 (77.6)
Type of treatment	No treatment	104 (22.4)
	Chemotherapy with or without EBR/BT	235 (50.5)
	EBR and/or BT	126 (27.1)
Disease recurrence	No	261 (56.1)
	Yes	204 (43.9)
Site of recurrence	Pelvis	60 (29.4)
	Abdomen	54 (26.5)
	Distant	90 (44.1)
Death	No	200 (42.9)
	Yes	266 (57.1)

		Pelvic – n (%)	Abdominal – n (%)	Distant – n (%)	Total – n (%)	p
2018 FIGO	IA	11 (37.9)	5 (17.2)	13 (44.8)	29 (100)	0.537
	IB	3 (25.0)	3 (25.0)	6 (50.0)	12 (100)
	II	11 (42.3)	2 (7.7)	13 (50.0)	26 (100)
	IIIA	6 (31.6)	5 (26.3)	8 (42.1)	19 (100)
	IIIB	3 (60.0)	1 (20.0)	1 (20.0)	5 (100)
	IIIC1	10 (24.4)	14 (34.1)	17 (41.5)	41 (100)
	IIIC2	5 (20.0)	8 (32.0)	12 (48.0)	25 (100)
	IVA	0 (0.0)	0 (0.0)	1 (100.0)	1 (100)
	IVB	11 (23.9)	16 (34.8)	19 (41.3)	46 (100)
2018 FIGO	I	14 (34.1)	8 (19.5)	19 (46.3)	41 (100)	0.179
	II	11 (42.3)	2 (7.7)	13 (50.0)	26 (100)
	III	24 (26.7)	28 (31.1)	38 (42.2)	90 (100)
	IV	11 (23.4)	16 (34.0)	20 (42.6)	47 (100)
Histological subtype	G3EA	9 (21.4)	12 (28.6)	21 (50.0)	42 (100)	0.551
	USC	17 (25.0)	18 (26.5)	33 (48.5)	68 (100)
	CCC	4 (22.2)	5 (27.8)	9 (50.0)	18 (100)
	CCS	15 (36.6)	11 (26.8)	15 (36.6)	41 (100)
	Mixed	15 (42.9)	8 (22.9)	12 (34.3)	35 (100)
Myoinvasion	No invasion	5 (50.0)	3 (30.0)	2 (20.0)	10 (100)	0.343
	Less than 50%	24 (33.3)	16 (22.2)	32 (44.4)	72 (100)
	More than 50%	31 (25.6)	34 (28.1)	56 (46.3)	121 (100)
	(Missing)	0 (0.0)	1 (100.0)	0 (0.0)	1 (100)
Myoinvasion	No or less than 50%	29 (35.4)	19 (23.2)	34 (41.5)	82 (100)	0.320
	More than 50%	31 (25.6)	34 (28.1)	56 (46.3)	121 (100)
	(Missing)	0 (0.0)	1 (100.0)	0 (0.0)	1 (100)

Variable – OS		All – n (%)	HR (95%CI; p-value) –univariate analysis	HR (95%CI; p-value) –multivariate analysis
Age at diagnosis (in years)	Mean (± SD)	65.9 (11.5)	1.04 (1.02–1.05; p < 0.001)	−
Age group (in years)	< 60	118 (25.3)	−	−
	≥ 60	348 (74.7)	2.37 (1.71–3.29; p < 0.001)	2.05 (1.45–2.89; p < 0.001)
Race	White	208 (44.6)	−	−
	Black	89 (19.1)	1.37 (1.00–1.89; p = 0.053)	−
	Non-white/black	169 (36.3)	1.23 (0.94–1.61; p = 0.139)	−
Race	White	208 (44.6)	−	−
	Non-white	258 (55.4)	1.28 (1.00–1.63; p = 0.050)	−
2018 FIGO	I	209 (44.8)	−	−
	II	58 (12.4)	2.26 (1.52–3.36; p < 0.001)	2.85 (1.88–4.31; p < 0.001)
	III	139 (29.8)	3.08 (2.27–4.16; p < 0.001)	4.81 (3.21–7.19; p < 0.001)
	IV	60 (12.9)	5.37 (3.75–7.70; p < 0.001)	8.03 (5.07–12.73; p < 0.001)
ECOG-PS	0	116 (25.3)	−	−
	1	297 (64.8)	3.26 (2.26–4.70; p < 0.001)	2.28 (1.55–3.35; p < 0.001)
	2	33 (7.2)	5.40 (3.25–8.98; p < 0.001)	3.20 (1.87–5.46; p < 0.001)
	3	12 (2.6)	8.63 (4.35–17.10; p < 0.001)	4.03 (1.90–8.55; p < 0.001)
Myoinvasion	No invasion	24 (5.2)	−	−
	Less than 50%	214 (46.0)	1.40 (0.71–2.77; p = 0.338)	−
	More than 50%	227 (48.8)	2.76 (1.40–5.41; p = 0.003)	−
Myoinvasion	No or less than 50%	238 (51.2)	−	−
	More than 50%	227 (48.8)	2.04 (1.59–2.60; p < 0.001)	1.55 (1.18–2.04; p = 0.002)
Histological subtype	G3EA	145 (31.1)	−	−
	USC	118 (25.3)	1.90 (1.37–2.64; p < 0.001)	1.56 (1.10–2.22; p = 0.013)
	CCC	44 (9.4)	1.47 (0.94–2.30; p = 0.095)	1.18 (0.73–1.88; p = 0.500)
	CCS	63 (13.5)	2.97 (2.04–4.32; p < 0.001)	2.35 (1.56–3.52; p < 0.001)
	Mixed	93 (20.0)	1.06 (0.72–1.56; p = 0.769)	0.92 (0.61–1.38; p = 0.674)
	NOS	3 (0.6)	0.00 (0.00–Inf; p = 0.991)	0.00 (0.00–Inf; p = 0.992)
Treatment	No treatment	104 (22.4)	−	−
	Chemotherapy with or without EBR/BT	235 (50.5)	0.75 (0.56–1.00; p = 0.052)	0.30 (0.20–0.44; p < 0.001)
	EBR and/or BT	126 (27.1)	0.46 (0.32–0.66; p < 0.001)	0.56 (0.38–0.83; p = 0.004)

Variable – RFS		All – n (%)	HR (95%CI; p-value) –univariate analysis	HR (95%CI; p-value) –univariate analysis
Age at diagnosis (in years)	Mean (± SD)	65.9 (11.5)	1.03 (1.02–1.04; p < 0.001)	−
Age group (in years)	< 60	118 (25.3)	−	−
	≥ 60	348 (74.7)	2.14 (1.56–2.92; p < 0.001)	1.87 (1.35–2.60; p < 0.001)
Race	White	208 (44.6)	−	−
	Black	89 (19.1)	1.32 (0.97–1.82; p = 0.081)	−
	Non-white/black	169 (36.3)	1.20 (0.92–1.56; p = 0.187)	−
Race	White	208 (44.6)	−	−
	Non-white	258 (55.4)	1.24 (0.98–1.57; p = 0.078)	−
2018 FIGO	I	209 (44.8)	−	−
	II	58 (12.4)	2.18 (1.47–3.25; p < 0.001)	2.65 (1.75–4.01; p < 0.001)
	III	139 (29.8)	3.31 (2.46–4.45; p < 0.001)	4.67 (3.17–6.86; p < 0.001)
	IV	60 (12.9)	7.01 (4.91–10.01; p < 0.001)	9.75 (6.22–15.29; p < 0.001)
ECOG-PS	0	116 (25.3)	−	−
	1	297 (64.8)	2.80 (1.99–3.95; p < 0.001)	1.90 (1.33–2.72; p < 0.001)
	2	33 (7.2)	4.13 (2.53–6.75; p < 0.001)	2.29 (1.36–3.84; p = 0.002)
	3	12 (2.6)	6.62 (3.39–12.95; p < 0.001)	2.83 (1.36–5.87; p = 0.005)
Myometrium invasion	No invasion	24 (5.2)	−	−
	Less than 50%	214 (46.0)	1.18 (0.63–2.20; p = 0.600)	−
	More than 50%	227 (48.8)	2.33 (1.26–4.30; p = 0.007)	−
Myoinvasion	No or less than 50%	238 (51.2)	−	−
	More than 50%	227 (48.8)	2.01 (1.58–2.55; p < 0.001)	1.53 (1.17–2.00; p = 0.002)
Histological subtype	G3EA	145 (31.1)	−	−
	USC	118 (25.3)	1.95 (1.41–2.68; p < 0.001)	1.53 (1.09–2.17; p = 0.015)
	CCC	44 (9.4)	1.43 (0.92–2.23; p = 0.110)	1.10 (0.69–1.74; p = 0.696)
	CCS	63 (13.5)	2.81 (1.94–4.08; p < 0.001)	2.19 (1.47–3.27; p < 0.001)
	Mixed	93 (20.0)	1.13 (0.78–1.64; p = 0.533)	0.99 (0.66–1.47; p = 0.946)
	NOS	3 (0.6)	0.00 (0.00–Inf; p = 0.990)	0.00 (0.00-Inf; p = 0.992)
Treatment	No treatment	104 (22.4)	−	−
	Chemotherapy with or without EBR/BT	235 (50.5)	0.82 (0.62–1.09; p = 0.178)	0.31 (0.22–0.46; p < 0.001)
	EBR and/or BT	126 (27.1)	0.44 (0.31–0.63; p < 0.001)	0.48 (0.32–0.70; p < 0.001)

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[1] Address for correspondence Andreia Cristina de Melo andreia.melo@inca.gov.br