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Endometrial cancer in an increasingly obese population: Exploring alternative options when surgery may not cut it

机译:越来越多的肥胖人群中的子宫内膜癌:在手术可能无法切除子宫内膜时探索其他选择

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Objectives The study objectives were to describe outcomes of obese patients with early endometrial cancer following primary non-surgical treatment, assess predictors of response, and estimate the increased surgical risk for these women. Methods Retrospective chart review identified women with early stage endometrial cancer at a single institution with BMI?≥?30?kg/m 2 who did not undergo surgery as primary treatment modality due to obesity and medical co-morbidities. Clinicopathologic factors were abstracted, characteristics of responders vs. non-responders compared and the National Surgical Quality Improvement Program (NSQIP) surgical risk calculator utilized to quantify surgical risks. Results Fifty-one patients were identified, with a mean BMI of 49.0?kg/m 2 . The NSQIP calculator predicted a significantly higher complication rate for our cohort compared to the expected average risk for hysterectomy (18.8% vs 7.2%, p ?
机译:目的研究目的是描述初次非手术治疗后肥胖的早期子宫内膜癌患者的结局,评估反应的预测因子,并评估这些妇女的手术风险增加。方法回顾性图表审查确定了在单一机构中BMI≥30?kg / m 2的患有早期子宫内膜癌的妇女,由于肥胖和医疗合并症而没有接受手术作为主要治疗方式。提取临床病理因素,比较反应者与非反应者的特征,并使用国家手术质量改善计划(NSQIP)手术风险计算器来量化手术风险。结果确定了51例患者,其BMI平均为49.0?kg / m 2。与子宫平均切除术的预期平均风险相比,NSQIP计算器预测我们队列的并发症发生率显着更高(18.8%vs 7.2%,p <0.001.0001)。大多数患者仅接受放射治疗(49%),然后接受激素治疗(45.1%)。接受激素治疗的妇女的缓解率为38.1%,而放射治疗组的缓解率为63.6%(p = ?. 063)。在NSQIP评分,BMI,合并症或年龄方面,应答者和非应答者之间没有发现显着差异。在患有持续性或进行性疾病的患者中,有87.5%的患者对二级治疗有反应。只有一名死亡是由于癌症进展。 2例患者因治疗并发症死亡(1例外科手术,1例化学疗法);其余十二人死于既往合并症。结论对于被认为手术并发症风险过高的肥胖患者,激素和放射疗法都是可行的选择。在这一人群中进行手术干预可能弊大于利。强调 ?对于高危女性,激素和放射疗法是安全的替代手术方法。 ?由于合并症而无法手术的肥胖女性非癌症死亡率高。 ?在高危妇女中进行手术可能几乎没有提供生存益处。

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