Hamilton C A, Cheung M K, Osann K, Chen L, Teng N N, Longacre T A, Powell M A, Hendrickson M R, Kapp D S, Chan J K
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA.
Br J Cancer. 2006 Mar 13;94(5):642-6. doi: 10.1038/sj.bjc.6603012.
To compare the survival of women with uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CC) to those with grade 3 endometrioid uterine carcinoma (G3EC). Demographic, pathologic, treatment, and survival information were obtained from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001. Data were analysed using Kaplan-Meier and Cox proportional hazards regression methods. Of 4180 women, 1473 had UPSC, 391 had CC, and 2316 had G3EC cancers. Uterine papillary serous carcinoma and CC patients were older (median age: 70 years and 68 vs 66 years, respectively; P<0.0001) and more likely to be black compared to G3EC (15 and 12% vs 7%; P<0.0001). A higher proportion of UPSC and CC patients had stage III-IV disease compared to G3EC patients (52 and 36% vs 29%; P<0.0001). Uterine papillary serous carcinoma, CC and G3EC patients represent 10, 3, and 15% of endometrial cancers but account for 39, 8, and 27% of cancer deaths, respectively. The 5-year disease-specific survivals for women with UPSC, CC and G3EC were 55, 68, and 77%, respectively (P<0.0001). The survival differences between UPSC, CC and G3EC persist after controlling for stage I-II (74, 82, and 86%; P<0.0001) and stage III-IV disease (33, 40, and 54; P<0.0001). On multivariate analysis, more favourable histology (G3EC), younger age, and earlier stage were independent predictors of improved survival. Women with UPSC and CC of the uterus have a significantly poorer prognosis compared to those with G3EC. These findings should be considered in the counselling, treating and designing of future trials for these high-risk patients.
比较子宫浆液性乳头状癌（UPSC）和透明细胞癌（CC）女性患者与Ⅲ级子宫内膜样癌（G3EC）女性患者的生存率。从1988年至2001年的监测、流行病学和最终结果计划中获取人口统计学、病理学、治疗及生存信息。使用Kaplan-Meier法和Cox比例风险回归方法对数据进行分析。在4180名女性中，1473例患有UPSC，391例患有CC，2316例患有G3EC癌症。与G3EC患者相比，子宫浆液性乳头状癌和CC患者年龄更大（中位年龄分别为70岁和68岁，而G3EC为66岁；P<0.0001），且更可能为黑人（分别为15%和12%，而G3EC为7%；P<0.0001）。与G3EC患者相比，UPSC和CC患者中Ⅲ-Ⅳ期疾病的比例更高（分别为52%和36%，而G3EC为29%；P<0.0001）。子宫浆液性乳头状癌、CC和G3EC患者分别占子宫内膜癌的10%、3%和15%，但分别占癌症死亡的39%、8%和27%。UPSC、CC和G3EC女性患者的5年疾病特异性生存率分别为55%、68%和77%（P<0.0001）。在控制Ⅰ-Ⅱ期（分别为74%、82%和86%；P<0.0001）和Ⅲ-Ⅳ期疾病（分别为33%、40%和54%；P<0.0001）后，UPSC、CC和G3EC之间的生存差异依然存在。多因素分析显示，更有利的组织学类型（G3EC）、更年轻的年龄和更早的分期是生存改善的独立预测因素。与G3EC患者相比，子宫UPSC和CC患者的预后明显更差。在为这些高危患者提供咨询、治疗和设计未来试验时应考虑这些发现。
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