Havrilesky Laura J, Secord Angeles Alvarez, Bae-Jump Victoria, Ayeni Tina, Calingaert Brian, Clarke-Pearson Daniel L, Berchuck Andrew, Gehrig Paola A
Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA.
Gynecol Oncol. 2007 Jun;105(3):677-82. doi: 10.1016/j.ygyno.2007.01.041. Epub 2007 Mar 13.
The optimal management of patients with stage I uterine papillary serous carcinoma (UPSC) is unclear. We sought to determine whether outcomes of women with surgical stage I UPSC differ with and without adjuvant therapy.
Retrospective multi-institution analysis of women with stage I UPSC surgically staged from 1976 to 2006.
comprehensive staging procedure including hysterectomy, bilateral salpingo-oophorectomy, selective pelvic/aortic lymphadenectomy, peritoneal cytology. Recurrence and survival were analyzed using Kaplan-Meier method.
Of 83 women with stage I UPSC, 36 (43%) received adjuvant therapies (23% radiotherapy, 3% chemotherapy, 15% chemotherapy and radiotherapy, 2% progestins). Three-year overall (OS) and progression-free survival (PFS) were 80% and 68%, respectively. Three-year OS and PFS by adjuvant treatment were observation (N=47) 86% and 78%, radiotherapy (N=17) 63% and 44%, chemotherapy with or without radiotherapy (N=17) 92% and 76%, respectively. Of the 18 recurrences, 9 (50%) included an extrapelvic component. Local recurrence was 2/30 (7%) following adjuvant radiotherapy and 7/53 (13%) without radiotherapy (p=0.48). Recurrence was higher in stage IB/IC (15/51, 29%) compared to stage IA (3/32, 9%). There has been one recurrence (5%) among the 22 women observed with stage IA disease.
In this largest reported series of women with surgical stage I UPSC, the high recurrence (29%) among patients with stage IB/IC disease highlights the need for clinical trials to test new therapeutic approaches. Surgically staged patients with IA disease had good prognosis. These data suggest that radiotherapy alone is not effective, that systemic therapy is needed, and that observation could be considered in patients with stage IA disease.
I期子宫浆液性乳头状癌（UPSC）患者的最佳治疗方案尚不清楚。我们试图确定手术分期为I期的UPSC女性患者接受辅助治疗与未接受辅助治疗的结局是否存在差异。
对1976年至2006年手术分期为I期的UPSC女性患者进行多机构回顾性分析。
全面分期手术，包括子宫切除术、双侧输卵管卵巢切除术、选择性盆腔/主动脉旁淋巴结清扫术、腹腔细胞学检查。采用Kaplan-Meier法分析复发率和生存率。
83例I期UPSC女性患者中，36例（43%）接受了辅助治疗（23%接受放疗，3%接受化疗，15%接受化疗和放疗，2%接受孕激素治疗）。三年总生存率（OS）和无进展生存率（PFS）分别为80%和68%。接受辅助治疗的患者三年OS和PFS情况如下：观察（N = 47）为86%和78%，放疗（N = 17）为63%和44%，化疗联合或不联合放疗（N = 17）为92%和76%。18例复发患者中，9例（50%）有盆腔外转移成分。辅助放疗后局部复发率为2/30（7%），未放疗者为7/53（13%）（p = 0.48）。IB/IC期（15/51，29%）的复发率高于IA期（3/32，9%）。22例IA期观察患者中有一例复发（5%）。
在该报道的最大系列手术分期为I期的UPSC女性患者中，IB/IC期患者的高复发率（29%）凸显了开展临床试验以测试新治疗方法的必要性。手术分期为IA期的患者预后良好。这些数据表明，单纯放疗无效，需要全身治疗，IA期患者可考虑观察。
