Pothuri Bhavana, Ramondetta Lois, Eifel Patricia, Deavers Michael T, Wilton Andrew, Alektiar Kaled, Barakat Richard, Soslow Robert A
Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA.
Gynecol Oncol. 2006 Dec;103(3):948-51. doi: 10.1016/j.ygyno.2006.05.039. Epub 2006 Jul 25.
Previous reports have suggested that patients who have undergone pelvic radiation for cervical cancer are at risk for developing poorly differentiated endometrial cancers with poor prognoses.
We conducted a retrospective chart and histologic review of patients from Memorial Sloan-Kettering Cancer Center and MD Anderson Cancer Center diagnosed with endometrial cancer after radiation therapy (RT) for cervical cancer from 1976 to 2000. The comparison group comprised MSKCC endometrial cancer patients whose tumors were not radiation associated ("sporadic cancers").
We identified 23 patients who developed endometrial carcinoma or carcinomasarcoma after RT for cervical carcinoma and 527 sporadic endometrial cancer patients. When radiation-associated endometrial cancers (RAECs) were compared with sporadic cancers, significant differences were noted with regard to stage, grade and histologic subtype distribution. In the RAEC group, there were 16 (70%) stages III and IV cancers compared with 101 (19%) in the sporadic group (P<0.001). There were 20 (87%) grade 3 cancers in the RAEC group versus 161 (31%) in the sporadic group (P<0.001). There were 16 (70%) high-risk histologic subtypes (serous, clear cell, carcinosarcoma, undifferentiated) in the RAEC group versus 79 (15%) in the sporadic group (P<0.001). Median survival in the RAEC group was 24 months versus not reached in the sporadic group (P<0.001). Radiation remained a significant factor for poor prognosis in a stratified analysis, in which we compared sporadic and RAEC cancers controlled for age, histology, grade and stage. However, radiation lost significance in a multivariate analysis, in which stage- and grade-matched cancers from both groups were compared.
The clinicopathologic characteristics of RAECs, which include a preponderance of high-stage, high-grade and high-risk histologic subtypes, indicate that these tumors differ from sporadic endometrial carcinomas. However, patients with RAECs do not appear to have a significantly worse prognosis when compared with patients with high-stage and high-grade sporadic cancers.
既往报告提示，接受过盆腔放疗的宫颈癌患者有发生预后不良的低分化子宫内膜癌的风险。
我们对1976年至2000年间在纪念斯隆凯特琳癌症中心和MD安德森癌症中心被诊断为宫颈癌放疗后发生子宫内膜癌的患者进行了回顾性病历及组织学检查。对照组包括肿瘤与放疗无关的MSKCC子宫内膜癌患者（“散发性癌症”）。
我们确定了23例宫颈癌放疗后发生子宫内膜癌或癌肉瘤的患者以及527例散发性子宫内膜癌患者。将放疗相关子宫内膜癌（RAEC）与散发性癌症进行比较时，在分期、分级和组织学亚型分布方面发现了显著差异。在RAEC组中，有16例（70%）为III期和IV期癌症，而散发性组为101例（19%）（P<0.001）。RAEC组有20例（87%）为3级癌症，散发性组为161例（31%）（P<0.001）。RAEC组有16例（70%）为高危组织学亚型（浆液性、透明细胞、癌肉瘤、未分化型），散发性组为79例（15%）（P<0.001）。RAEC组的中位生存期为24个月，而散发性组未达到（P<0.001）。在一项分层分析中，放疗仍然是预后不良的一个重要因素，在该分析中我们比较了根据年龄、组织学、分级和分期进行对照的散发性和RAEC癌症。然而，在一项多变量分析中放疗失去了显著性，在该分析中比较了两组分期和分级匹配的癌症。
RAEC的临床病理特征，包括高分期、高分级和高危组织学亚型占优势，表明这些肿瘤与散发性子宫内膜癌不同。然而，与高分期和高分级散发性癌症患者相比，RAEC患者的预后似乎并没有明显更差。
