Bristow R E, Zahurak M L, Alexander C J, Zellars R C, Montz F J
The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Int J Gynecol Cancer. 2003 Sep-Oct;13(5):664-72. doi: 10.1046/j.1525-1438.2003.13385.x.
The objective of this study was to evaluate the potential survival benefit of debulking macroscopic adenopathy and other clinical prognostic factors among patients with node-positive endometrial carcinoma. Demographic, operative, pathologic, and follow-up data were abstracted retrospectively for 41 eligible patients with FIGO stage IIIC endometrial cancer. Survival curves were generated using the Kaplan-Meier method and statistical comparisons were performed using the log rank test, logistic regression analysis, and the Cox proportional hazards regression model. All patients had positive pelvic lymph nodes and 20 patients (48.8%) had positive para-aortic lymph nodes. Postoperatively, all patients received whole pelvic radiation therapy, 17 received extended-field radiation therapy, and 15 patients received chemotherapy. The median disease-specific survival (DSS) time for all patients was 30.6 months (median follow-up 34. 0 months). Patients with completely resected macroscopic lymphadenopathy had a significantly longer median DSS time (37.5 months), compared to patients left with gross residual nodal disease (8.8 months, P = 0.006). On multivariate analysis, independent predictors of DSS were gross residual nodal disease (HR 7.96, 95% CI 2.54-24.97, P < 0. 001), age > or = 65 years (HR 6.22, 95% CI 2.05-18.87, P = 0.001), and the administration of adjuvant chemotherapy (HR 0.22, 95% CI 0.07-0.76, P = 0.016). We conclude that in patients with stage IIIC endometrial carcinoma, complete resection of macroscopic nodal disease and the administration of adjuvant chemotherapy, in addition to directed radiation therapy, are associated with improved survival.
本研究的目的是评估在淋巴结阳性的子宫内膜癌患者中，切除大体可见的肿大淋巴结的潜在生存获益以及其他临床预后因素。对41例符合条件的国际妇产科联盟（FIGO）IIIC期子宫内膜癌患者的人口统计学、手术、病理和随访数据进行了回顾性提取。使用Kaplan-Meier方法生成生存曲线，并使用对数秩检验、逻辑回归分析和Cox比例风险回归模型进行统计比较。所有患者盆腔淋巴结均为阳性，20例患者（48.8%）腹主动脉旁淋巴结为阳性。术后，所有患者均接受了全盆腔放疗，17例接受了扩大野放疗，15例患者接受了化疗。所有患者的疾病特异性生存（DSS）时间中位数为30.6个月（中位随访时间34.0个月）。与残留有明显淋巴结疾病的患者相比，大体可见的淋巴结完全切除的患者DSS时间中位数显著更长（37.5个月对8.8个月，P = 0.006）。多因素分析显示，DSS的独立预测因素为残留明显淋巴结疾病（风险比[HR] 7.96，95%可信区间[CI] 2.54 - 24.97，P < 0.001）、年龄≥65岁（HR 6.22，95% CI 2.05 - 18.87，P = 0.001）以及辅助化疗的使用（HR 0.22，95% CI 0.07 - 0.76，P = 0.016）。我们得出结论，在IIIC期子宫内膜癌患者中，除了定向放疗外，完全切除大体可见的淋巴结疾病以及使用辅助化疗与生存改善相关。
