Kwon J S, Carey M S, Cook E F, Qiu F, Paszat L
Division of Gynecologic Oncology, University of Western Ontario, London, Ontario, Canada.
Int J Gynecol Cancer. 2007 Mar-Apr;17(2):433-40. doi: 10.1111/j.1525-1438.2007.00812.x. Epub 2007 Feb 2.
To evaluate patterns of practice and outcomes in intermediate- and high-risk stage I and II endometrial cancer in the province of Ontario, Canada. This was a retrospective population-based study of women diagnosed with stage I and II endometrial cancer in Ontario from 1996 to 2000. After excluding low-risk (stages IA and IB, grades 1 and 2) and nonendometrioid histologies, the population was stratified into two risk groups: intermediate risk (stages IA and IB, grade 3; stages IC and IIA, grades 1 and 2; stage IIA, grade 3 if <50% myometrial invasion) and high risk (stage IC, grade 3; stage IIA, grade 3 if >50% myometrial invasion, and all stage IIB). Patterns of practice were assessed in each risk group, including use of surgical staging and adjuvant pelvic radiotherapy (APRT). Cox proportional hazards models determined effects of prognostic factors on 5-year overall survival (OS), including age, income, comorbidities, lymphvascular space invasion (LVSI), surgical staging, and APRT. There were 995 women in this study: 748 intermediate risk (75.2%) and 247 high risk (24.8%). Only 69 (9.2%) and 40 (16.2%) women underwent surgical staging in the intermediate- and high-risk groups, respectively. Surgical staging did not reduce rates of APRT. Determinants of survival included age >60 and comorbidities in the intermediate-risk group, and age >60, income, and LVSI in the high-risk group. In this population-based study, there were variable patterns of practice for intermediate- and high-risk stage I and II endometrial cancer. Surgical staging and APRT did not affect OS.
评估加拿大安大略省中高危Ⅰ期和Ⅱ期子宫内膜癌的治疗模式及治疗结果。这是一项基于人群的回顾性研究，研究对象为1996年至2000年在安大略省被诊断为Ⅰ期和Ⅱ期子宫内膜癌的女性。排除低风险（ⅠA和ⅠB期，1级和2级）和非子宫内膜样组织学类型后，将人群分为两个风险组：中风险组（ⅠA和ⅠB期，3级；ⅠC和ⅡA期，1级和2级；ⅡA期，若肌层浸润<50%则为3级）和高风险组（ⅠC期，3级；ⅡA期，若肌层浸润>50%则为3级，以及所有ⅡB期）。评估每个风险组的治疗模式，包括手术分期和辅助盆腔放疗（APRT）的使用情况。Cox比例风险模型确定了预后因素对5年总生存率（OS）的影响，包括年龄、收入、合并症、淋巴管间隙浸润（LVSI）、手术分期和APRT。本研究共有995名女性：748名中风险组（75.2%）和247名高风险组（24.8%）。中风险组和高风险组分别仅有69名（9.2%）和40名（16.2%）女性接受了手术分期。手术分期并未降低APRT的使用率。生存的决定因素包括中风险组中年龄>60岁和合并症，以及高风险组中年龄>60岁、收入和LVSI。在这项基于人群的研究中，中高危Ⅰ期和Ⅱ期子宫内膜癌的治疗模式存在差异。手术分期和APRT并未影响总生存率。
