Infiltración linfovascular en cáncer de endometrio, implicación en la supervivencia y recidiva. Análisis retrospectivo Fernandez-Gonzalez S, Gomez-Roig M.D, Gonzalez E Servicio de Ginecología y Obstericia Hospital Sant Joan de Déu, Universitat de Barcelona.
INTRODUCCIÓN El 75 % de las pacientes con cáncer de endometrio se diagnostican en estadios precoces La supervivencia a los 5 años es del 89,8% La tasa de recurrencia a los 5 años es del 11% Comorbilidades en > 50% pacientes Cirugía (linfadenectomía) permanece en debate Factores pronósticos intermedios Adecuar el tratamiento adyuvante - Edad avanzada - G2-G3 - Invasión miometrial - Infiltración del espacio linfovascular
INTRODUCCIÓN BUEN CONTROL LOCAL IMPACTO EN LA SUPERVIVENCIA POCO IMPACTO en OS vs POCO IMPACTO RECIDIVA RDT: estudio 1: Menos recurrencia de 12% con RDT vs 3% sin RDT. HR 0.42/P=0.007. OS 92% con RDT vs 86% sin RDT. HR 0.86/P=0.557 2º ESTUDIO: Control pelvico 93% (usando mas RDT) 97% (usando menos RDT) p=0.3. OS: 84% (usando mas RDT) vs 96% (usando menos RDT) p=0.09 3er estudio: EBRT statistically significantly reduced locoregional recurrence compared with no EBRT (or VBT alone) (HR = 0.36, 95% confidence Interval [CI] = 0.25 to 0.52; P < .001), but this did not translate into an improvement in OS (HR = 0.99, 95% CI = 0.82 to 1.20; P = .95), Estudio 4 RDT: Results. 33,600 patients met criteria. 18,070 patients (53.8%) received surgery alone, 15,530 patients (46.2%) re- ceived surgery + adjuvant RT. Of patients who received adjuvant RT, 42.2% received external beam RT, 44.7% brachytherapy, and 13.1% received both. 5-year OS was 79.2% for the surgery alone group and 83.3% for the surgery + adjuvant RT (p b 0.0001) QT: Estudio 1º: However, among 120 patients in a high- to intermediate-risk group defined as (1) stage IC in patients over 70 years old or with G3 endometrioid adenocarcinoma or (2) stage II or IIIA (positive cytology), the CAP group had a significantly higher PFS rate (83.8% vs. 66.2%, log-rank test P = 0.024, hazard ratio 0.44) and higher OS rate (89.7% vs. 73.6%, log-rank test P = 0.006, hazard ratio 0.24) Estudio 2: SOBRETODO SON II-III stage! Indiscriminate pooling of survival data from 2197 women shows a significant overall survival advantage from adjuvant chemotherapy (RR (95% CI) = 0.88 (0.79 to 0.99)) number needed to treat for an additional beneficial outcome (NNT) = 25; absolute risk reduction = 4% (1% to 8%)). The HR for overall survival is 0.74 (0.64 to 0.89), significantly favouring the addition of postoperative platinum based chemotherapy. The HR for progression-free survival is 0.75 (0.64 to 0.89). This means that chemotherapy reduces the risk of being dead at any censorship by a quarter. Chemotherapy reduces the risk of developing the first recurrence outside the pelvis (RR = 0.79 (0.68 to 0.92), 5% absolute risk reduction; NNT = 20). The analysis of pelvic recurrence rates is underpowered but the trend suggests that chemotherapy may be less effective than radiotherapy in a direct comparison (RR = 1.28 (0.97 to 1.68)) but it may have added value when used with radiotherapy (RR = 0.48 (0.20 to 1.18)). AUTORS CONCLUSION: Postoperative platinum based chemotherapy is associated with a small benefit in progression-free survival and overall survival irrespective of radiotherapy treatment. It reduces the risk of developing a metastasis, could be an alternative to radiotherapy and has added value when used with radiotherapy. 3er estudio: comparan RDT+CT vs RDT en pacientes estadio I-IIIA con factores mal PX. In the combined anal- ysis, overall survival approached statistical significance (HR 0.69, CI 0.46–1.03; P = 0.07) and cancer-specific survival (CSS) was significant (HR 0.55, CI 0.35–0.88; P = 0.01). 4º. Explica la situacion actual y concluye eso… q parece q la CT añade valor a la OS std en estadios avanzados o estadios precoces con factores mal Px
OBJETIVO Dada la controversia actual con el tratamiento adyuvante, nuestro objetivo fue analizar la supervivencia y la tasa de recidiva en función de la presencia o no infiltración linfovascular. MÉTODOS Análisis retrospectivo 294 pacientes diagnosticas de cáncer endometrial en nuestro centro entre 1990-2015. Recogimos: Datos epidemiológicos Estadios FIGO Tratamiento primario Infiltración espacio Linfovascular Subtipos histológicos Tasas de OS, Recidiva, ILE
RESULTADOS
RESULTADOS
RESULTADOS 149 meses 97 meses P < 0.001 69.7 meses 19 meses P 0.13
CONCLUSIONES La afectación del espacio linfovascular se podría relacionar con: Subtipos histológicos de peor pronóstico Mayor grado Mayor estadio FIGO Peor supervivencia global Más tasas de recidivas
GRACIAS sfernandezgo@HSJDBCN.ORG