Phelan C, Montag A G, Rotmensch J, Waggoner S E, Yamada S D, Mundt A J
Departments of Obstetrics and Gynecology, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
Gynecol Oncol. 2001 Dec;83(3):513-7. doi: 10.1006/gyno.2001.6407.
The objective was to evaluate the clinicopathologic characteristics and outcome of pathologic stage I endometrial carcinoma patients with lower uterine segment (LUS) involvement.
We retrospectively reviewed the characteristics and outcomes of pathologic stage I endometrial carcinoma patients treated with primary surgery at our institution between 1988 and 1998. The significance of LUS involvement was examined with univariate and multivariate analyses. Median patient follow-up was 37.3 months.
Of the 98 cases reviewed, 41 (42%) had LUS involvement. No differences were seen in the clinicopathologic features, extent of surgical staging, or adjuvant therapies between patients with and without LUS involvement. Univariate analysis revealed that grade, lymphovascular invasion (LVI), myometrial invasion (MI), and histology were correlated with recurrence. While the 5-year actuarial disease-free survival was worse in women with LUS involvement (80.3 vs 94.0%) compared to those without, this difference did not reach statistical significance (P = 0.14). Moreover, after controlling for pathologic features in a multivariate model, LUS involvement was not correlated with patient outcome (P = 0.98; hazard rate 0.97; 95% confidence interval 0.24, 4.0). LUS was also not correlated with pelvic recurrence. Of 25 low-risk patients (superficial MI and grade 1-2 disease) with LUS involvement, none recurred in the pelvis following surgery alone. In contrast, pelvic recurrence was common (5/12 or 41.6%) in high-risk patients (deep MI and/or grade 3 tumors) following surgery alone regardless of LUS involvement.
LUS involvement is common in pathologic stage I endometrial carcinoma but is not correlated with a worse outcome. Moreover, in the absence of adverse pathologic features, LUS involvement is not associated with an increased risk of pelvic recurrence and should not be used as an indication for adjuvant radiation therapy.
评估子宫下段（LUS）受累的病理I期子宫内膜癌患者的临床病理特征及预后。
我们回顾性分析了1988年至1998年间在我院接受初次手术治疗的病理I期子宫内膜癌患者的特征及预后。采用单因素和多因素分析研究LUS受累的意义。患者中位随访时间为37.3个月。
在回顾的98例病例中，41例（42%）有LUS受累。LUS受累和未受累患者在临床病理特征、手术分期范围或辅助治疗方面未见差异。单因素分析显示，分级、淋巴管浸润（LVI）、肌层浸润（MI）和组织学与复发相关。虽然LUS受累的女性5年无病生存率（80.3%对94.0%）低于未受累女性，但差异无统计学意义（P = 0.14）。此外，在多因素模型中控制病理特征后，LUS受累与患者预后无关（P = 0.98；风险率0.97；95%置信区间0.24，4.0）。LUS也与盆腔复发无关。在25例LUS受累的低风险患者（浅表MI和1-2级疾病）中，仅手术治疗后盆腔均未复发。相比之下，无论LUS是否受累，高风险患者（深部MI和/或3级肿瘤）仅手术治疗后盆腔复发常见（5/12或41.6%）。
LUS受累在病理I期子宫内膜癌中常见，但与较差预后无关。此外，在没有不良病理特征的情况下，LUS受累与盆腔复发风险增加无关，不应作为辅助放疗的指征。
