Alektiar Kaled M, McKee Andrea, Lin Oscar, Venkatraman Ennapadam, Zelefsky Michael J, Mychalczak Boris R, McKee Brady, Hoskins William J, Barakat Richard R
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA.
Cancer. 2002 Jul 15;95(2):316-21. doi: 10.1002/cncr.10660.
The 1988 International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial carcinoma defined Stage IB as disease with invasion of less than one-half of the myometrium, although most of the data on prognostic factors are based on invasion of the inner one-third, middle one-third, or outer one-third of the myometrium. The objective of this study was to determine whether the depth of myometrial invasion is correlated with outcome in patients with Stage IB endometrial carcinoma.
Between November, 1987 and June, 1998, 251 patients with Stage IB endometrioid adenocarcinoma of the uterus underwent simple hysterectomy followed by intravaginal brachytherapy. The depth of myometrial invasion was less than or equal to one-third (Group I) in 191 of 251 patients (79%) and greater than one-third to less than one-half (Group II) in 52 of 251 patients (21%). Comprehensive surgical staging (CSS) was done in 12% of patients. The two groups were balanced with regard to age (< 60 years vs. > or = 60 years), FIGO grade, lower uterine segment involvement (LUSI), CSS, and the use of postoperative external-beam radiation. The rate of capillary-like space invasion (CLSI), however, was 9% in Group I compared with 25% in Group II (P = 0.002). The median follow-up was 58 months.
The overall 5-year actuarial local-regional control (LRC), disease free (DFS) survival, and overall survival (OS) rates were 95%, 92%, and 92%, respectively. These end points, however, did not vary significantly between the two groups. The 5-year LRC, DFS, and OS rates in Groups I and II were 96% versus 95%, respectively (P = 0.9); 92% versus 94%, respectively (P = 0.7); and 92% versus 90%, respectively (P = 0.5). On multivariate analysis, the influence on outcome of age, grade, amount of myometrial invasion, LUSI, and CLSI was evaluated. Only age > or = 60 years and FIGO Grade 3 were correlated with poor DFS (P = 0.02 and P = 0.03, respectively) and OS (P = 0.001 and P = 0.01, respectively).
Based on this study, in patients with Stage IB endometrial carcinoma, the amount of myometrial invasion, defined as invasion less than or equal to one-third of the myometrium versus invasion greater than one-third and less than one-half of the myometrium, did not appear to influence outcome. Age > or = 60 years and FIGO Grade 3, however, emerged as independent prognostic factors for poor DFS and OS.
1988年国际妇产科联盟（FIGO）的子宫内膜癌分期系统将ⅠB期定义为肌层浸润少于一半的疾病，尽管大多数关于预后因素的数据是基于肌层内三分之一、中三分之一或外三分之一的浸润情况。本研究的目的是确定ⅠB期子宫内膜癌患者的肌层浸润深度与预后是否相关。
在1987年11月至1998年6月期间，251例ⅠB期子宫子宫内膜样腺癌患者接受了单纯子宫切除术，随后进行阴道内近距离放疗。251例患者中，191例（79%）肌层浸润深度小于或等于三分之一（Ⅰ组），52例（21%）肌层浸润深度大于三分之一至小于二分之一（Ⅱ组）。12%的患者进行了全面手术分期（CSS）。两组在年龄（<60岁与≥60岁）、FIGO分级、子宫下段受累（LUSI）、CSS以及术后外照射的使用方面是平衡的。然而，Ⅰ组的毛细血管样间隙浸润（CLSI）率为9%，而Ⅱ组为25%（P = 0.002）。中位随访时间为58个月。
总体5年精算局部区域控制（LRC）、无病（DFS）生存率和总生存率（OS）分别为95%、92%和92%。然而，这些终点在两组之间没有显著差异。Ⅰ组和Ⅱ组的5年LRC、DFS和OS率分别为96%对95%（P = 0.9）；92%对94%（P = 0.7）；92%对90%（P = 0.5）。在多变量分析中，评估了年龄、分级、肌层浸润量、LUSI和CLSI对预后的影响。只有年龄≥60岁和FIGO 3级与较差的DFS（分别为P = 0.02和P = 0.03）和OS（分别为P = 0.001和P = 0.01）相关。
基于本研究，在ⅠB期子宫内膜癌患者中，定义为肌层浸润小于或等于三分之一与肌层浸润大于三分之一至小于二分之一的肌层浸润量似乎不影响预后。然而，年龄≥60岁和FIGO 3级成为DFS和OS较差的独立预后因素。
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