Havrilesky Laura J, Cragun Janiel M, Calingaert Brian, Alvarez Secord Angeles, Valea Fidel A, Clarke-Pearson Daniel L, Berchuck Andrew, Soper John T
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Box 3079, Durham, NC 27710, USA.
Gynecol Oncol. 2007 Feb;104(2):401-5. doi: 10.1016/j.ygyno.2006.08.027. Epub 2006 Oct 2.
The clinical significance and optimal management of patients with stage IIIA endometrial cancer are controversial. We sought to determine whether recurrence and survival of patients with stage IIIA endometrial cancer differ with surgical pathologic findings (positive peritoneal cytology versus positive adnexae or serosa) and adjuvant treatment.
Retrospective single institution analysis of patients surgically staged for IIIA endometrial cancer at Duke University Medical Center from 1973 to 2002. Stage IIIA patients were stratified into positive cytology alone (group IIIA1, n=37) and positive adnexae or uterine serosa (group IIIA2, n=20). Comparison was made with previously reported group of 467 patients with surgical stage I/II disease. Recurrence and survival were analyzed using Kaplan-Meier estimations and Cox proportional hazards model.
Mean age of 57 patients with stage IIIA endometrial cancer was 63. Adjuvant therapies were administered to 89% patients (74% radiotherapy, 4% chemotherapy, 19% progestins). Five-year overall (OS) and recurrence-free disease-specific survival (RFDSS) were 64% and 76%, respectively. Survival was similar comparing IIIA1 (62%) and IIIA2 (68%, p=0.999). RFDSS by adjuvant therapy was: external beam radiotherapy 89% (n=10), intraperitoneal P32 84% (n=21), progestins 78% (n=9), none 75% (n=6). 61% recurrences included extrapelvic component. In multivariable analysis of stage I-IIIA patients (n=517), positive cytology but not adnexal/serosal metastasis was predictive of death (HR 1.70, 95% CI 1.06-2.73) and disease recurrence (HR 1.70, 95% CI 1.07-2.71).
Among patients with stage IIIA endometrial cancer, metastasis to adnexae or serosa does not appear to confer worse prognosis than positive cytology alone. Positive cytology is an independent predictor of prognosis among patients with stage I-IIIA endometrial cancer. While optimal adjuvant therapy for these groups remains unclear, recurrence patterns suggest that systemic therapies are appropriate.
ⅢA期子宫内膜癌患者的临床意义及最佳治疗方案存在争议。我们试图确定ⅢA期子宫内膜癌患者的复发和生存情况是否因手术病理结果（阳性腹腔细胞学检查与阳性附件或浆膜）及辅助治疗而有所不同。
对1973年至2002年在杜克大学医学中心接受ⅢA期子宫内膜癌手术分期的患者进行单机构回顾性分析。ⅢA期患者被分为单纯细胞学阳性组（ⅢA1组，n = 37）和附件或子宫浆膜阳性组（ⅢA2组，n = 20）。与之前报道的467例手术分期为I/II期疾病的患者组进行比较。使用Kaplan-Meier估计法和Cox比例风险模型分析复发和生存情况。
57例ⅢA期子宫内膜癌患者的平均年龄为63岁。89%的患者接受了辅助治疗（74%为放疗，4%为化疗，19%为孕激素治疗）。5年总生存率（OS）和无复发生存率（RFDSS）分别为64%和76%。ⅢA1组（62%）和ⅢA2组（68%，p = 0.999）的生存率相似。辅助治疗后的RFDSS情况如下：体外照射放疗为89%（n = 10），腹腔内P32为84%（n = 21），孕激素为78%（n = 9），未接受辅助治疗为75%（n = 6）。61%的复发包括盆腔外成分。在对I-IIIA期患者（n = 517）的多变量分析中，细胞学阳性而非附件/浆膜转移是死亡（风险比[HR] 1.70，95%置信区间[CI] 1.06 - 2.73）和疾病复发（HR 1.70，95% CI 1.07 - 2.71）的预测因素。
在ⅢA期子宫内膜癌患者中，附件或浆膜转移似乎并不比单纯细胞学阳性预后更差。细胞学阳性是I-IIIA期子宫内膜癌患者预后的独立预测因素。虽然这些患者组的最佳辅助治疗仍不明确，但复发模式表明全身治疗是合适的。
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