Yalman D, Ozsaran Z, Anacak Y, Celik O K, Ozkök S, Ozsaran A, Hanhan M, Haydaroğlu A
Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey.
Eur J Gynaecol Oncol. 2000;21(3):311-5.
The aim of this study was to determine the prognostic factors influencing overall, disease-free and local recurrence-free survival in patients treated postoperatively with adjuvant radiotherapy for endometrial carcinoma.
The records of 440 patients with endometrial carcinoma treated by postoperative radiotherapy between January 1985 and June 1997 were reviewed retrospectively. All patients received postoperative external radiotherapy with 1.8-2.0 Gy daily fractions up to 36-68 Gy (median 54 Gy). Intracavitary brachytherapy was applied to 61.8% of the cases. Survival analysis was performed using the Kaplan-Meier method. The log-rank test was used for univariate analysis and the Cox regression model for multivariate analysis.
Median age of the patients was 57 (range: 35-83). Histologically 80.2% were adenocarcinoma, 5.7% adenosquamous carcinoma, 5.2% clear-cell carcinoma and 4.3% serous papillary carcinoma. The distribution by stages were: 62.2% Stage I, 20.0% Stage II, 14.9% Stage III, 2.8% Stage IV. Median follow-up time was 53 months (7-173 months). Total failure rate was 15.2% with 2.7% of patients having only local failure, 2.0% local and distant failure and 10.5% distant failure only. Five-year overall, disease-free and local recurrence-free survival rates were 81.6%, 80.7% and 94.6%, respectively. According to univariate analysis prognostic factors influencing disease-free survival were histologic type (p=0.0067), histologic grade (p=0.0015), stage (p<0.0001), myometrial invasion (p<0.0001), peritoneal cytology (p=0.0013) and cervical involvement (p=0.0106) while the prognostic factors affecting local recurrence-free survival were stage (p=0.0277), myometrial invasion (p=0.0054), peritoneal cytology (p=0.0427). According to multivariate analysis prognostic factors influencing disease-free survival were histologic type (p=0.0194), myometrial invasion (p=0.0021), and histologic grade (p=0.0303) while the only prognostic factor influencing local recurrence-free survival was myometrial invasion (p=0.0241).
Radiotherapy is a highly effective adjuvant treatment providing an excellent locoregional control rate and it should be continued for patients with unfavorable prognostic factors.
本研究旨在确定影响子宫内膜癌患者术后接受辅助放疗后的总生存期、无病生存期和局部无复发生存期的预后因素。
回顾性分析1985年1月至1997年6月间440例行术后放疗的子宫内膜癌患者的病历。所有患者均接受术后体外放疗，每日分次剂量为1.8 - 2.0 Gy，总量达36 - 68 Gy（中位剂量54 Gy）。61.8%的病例接受了腔内近距离放疗。采用Kaplan-Meier法进行生存分析。单因素分析采用对数秩检验，多因素分析采用Cox回归模型。
患者的中位年龄为57岁（范围：35 - 83岁）。组织学类型方面，腺癌占80.2%，腺鳞癌占5.7%，透明细胞癌占5.2%，浆液性乳头状癌占4.3%。分期分布为：Ⅰ期62.2%，Ⅱ期20.0%，Ⅲ期14.9%，Ⅳ期2.8%。中位随访时间为53个月（7 - 173个月）。总失败率为15.2%，其中仅局部失败的患者占2.7%，局部和远处均失败的占2.0%，仅远处失败的占10.5%。5年总生存期、无病生存期和局部无复发生存率分别为81.6%、80.7%和94.6%。单因素分析显示，影响无病生存期的预后因素有组织学类型（p = 0.0067）、组织学分级（p = 0.0015）、分期（p < 0.0001）、肌层浸润（p < 0.0001）、腹腔细胞学检查（p = 0.0013）和宫颈受累情况（p = 0.0106）；影响局部无复发生存期的预后因素有分期（p = 0.0277）、肌层浸润（p = 0.0054）、腹腔细胞学检查（p = 0.0427）。多因素分析显示，影响无病生存期的预后因素有组织学类型（p = 0.0194）、肌层浸润（p = 0.0021）和组织学分级（p = 0.0303）；影响局部无复发生存期的唯一预后因素是肌层浸润（p = 0.0241）。
放疗是一种高效的辅助治疗方法，能提供出色的局部区域控制率，对于预后不良因素的患者应继续采用。
