Background:The impact of cytoreductive surgery on survival in patients with FIGO stage IVB endometrial cancer remains controversial. This study aimed to evaluate the independent effect of surgery within contemporary multimodal treatment strategies using a large population-based registry.Patients and methods:We conducted a multicenter retrospective analysis of 6582 patients with endometrial cancer recorded in the Saxony-Anhalt cancer registry between 2000 and 2020. After exclusions, 294 patients with FIGO stage IVB disease were included. Disease-free survival (DFS) was the primary outcome and overall survival (OS) the secondary outcome. Patients were initially categorized into three treatment groups: surgery only, non-surgical therapy, and combined multimodal therapy. To address potential selection bias, a propensity score-based inverse probability of treatment weighting (IPTW) analysis was performed to compare surgery versus no surgery. Time-period subgroup analysis was conducted for 2000–2010 and 2011–2019.Results:The median follow-up was 68 months (range 0–265 months). Combination therapy resulted in significantly improved median DFS and OS compared to surgery or non-surgical therapy alone. After IPTW adjustment, surgery was independently associated with improved OS (HR 0.64, 95% CI 0.53–0.78,p< 0.01) and DFS (HR 0.67, 95% CI 0.48–0.94,p= 0.02). Subgroup analysis demonstrated a significant survival benefit of surgery in the contemporary period (2011–2019), whereas the effect was weaker and not statistically significant in the earlier period (2000–2010).Conclusions:Cytoreductive surgery is independently associated with improved survival in patients with FIGO stage IVB endometrial cancer, particularly within modern therapeutic eras. These findings support the integration of surgery as part of a multimodal approach in selected patients while highlighting the importance of refined patient selection in the context of evolving systemic therapies.
背景：肿瘤细胞减灭术对国际妇产科联盟（FIGO）IVB期子宫内膜癌患者生存期的影响仍存在争议。本研究旨在基于大规模人群登记数据，评估当代多模式治疗策略中手术的独立效应。 患者与方法：我们对2000年至2020年间萨克森-安哈尔特癌症登记处记录的6582例子宫内膜癌患者进行了多中心回顾性分析。经排除后，共纳入294例FIGO IVB期患者。主要结局指标为无病生存期（DFS），次要结局指标为总生存期（OS）。患者初始分为三组治疗方式：单纯手术、非手术治疗及联合多模式治疗。为控制潜在选择偏倚，采用基于倾向评分的逆概率处理加权（IPTW）分析法比较手术与非手术组。并按时间段（2000–2010年与2011–2019年）进行亚组分析。 结果：中位随访时间为68个月（范围0–265个月）。联合治疗组的中位DFS和OS显著优于单纯手术或非手术治疗组。经IPTW校正后，手术与OS改善（HR 0.64，95% CI 0.53–0.78，p<0.01）及DFS改善（HR 0.67，95% CI 0.48–0.94，p=0.02）独立相关。亚组分析显示，手术在当代时期（2011–2019年）具有显著生存获益，而在早期（2000–2010年）效果较弱且无统计学意义。 结论：肿瘤细胞减灭术与FIGO IVB期子宫内膜癌患者生存改善独立相关，在现代治疗时代尤为显著。这些发现支持将手术作为多模式治疗的一部分应用于经选择的患者，同时强调在全身治疗不断发展的背景下，精细化患者选择具有重要意义。
肿瘤(癌症)患者之家