Thomas M, Mariani A, Wright J D, Madarek E O S, Powell M A, Mutch D G, Podratz K C, Dowdy S C
Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Gynecol Oncol. 2008 Feb;108(2):293-7. doi: 10.1016/j.ygyno.2007.11.008. Epub 2007 Dec 21.
To assess the role of surgical staging, adjuvant therapy, and cytoreduction in uterine clear cell carcinoma (UCCC).
A retrospective review was conducted at 2 major gynecologic cancer centers of all primary UCCC between 1982 and 2004.
UCCC was confirmed in 99 patients. The 5-year overall survival (OS) was 79%, 77%, 47%, and 21% for stages I-IV respectively. 69 patients had no gross evidence of extra-uterine disease, but 36 (52%) were upstaged at surgery. For those 22 patients with stages I and II disease who had a systematic lymphadenectomy (LND) (> 20 lymph nodes), no lymphatic (LF), peritoneal (PF), or hematological (HF) failures were noted. Radiation (RT) improved PFS (67 vs. 36%, p=0.02), and reduced pelvic sidewall recurrences (18 vs. 53%, p=0.04) and vaginal failures (VF) (7 vs. 35%, p=0.04) for 45 patients at risk for LF (positive nodes or suboptimal LND). 39 patients with stages IIIC and IV disease were separately analyzed. Patients with no visible residual disease after cytoreduction had a significant improvement in median PFS (17 vs. 7 months, p<0.001), and OS (40 vs. 18 months, p=0.02) compared to patients with any residual disease after surgery.
Comprehensive surgical staging with a systematic LND is essential to accurately define early stage UCCC. Vaginal brachytherapy may be adequate adjuvant therapy for stages I and II UCCC confirmed by systematic LND. Patients at risk for LF appear to benefit from pelvic RT. An effort at cytoreduction to no visible residual disease should be made in advanced UCCC when feasible.
评估手术分期、辅助治疗及肿瘤细胞减灭术在子宫透明细胞癌（UCCC）中的作用。
对1982年至2004年间两家主要妇科癌症中心的所有原发性UCCC患者进行回顾性研究。
确诊UCCC患者99例。Ⅰ - Ⅳ期患者的5年总生存率分别为79%、77%、47%和21%。69例患者无子宫外疾病的大体证据，但36例（52%）在手术中被上调分期。对于22例接受系统性淋巴结清扫（LND）（> 20个淋巴结）的Ⅰ期和Ⅱ期疾病患者，未发现淋巴转移（LF）、腹膜转移（PF）或血液转移（HF）。对于45例有LF风险（阳性淋巴结或LND不充分）的患者，放疗（RT）改善了无进展生存期（PFS）（67%对36%，p = 0.02），并减少了盆腔侧壁复发（18%对53%，p = 0.04）和阴道转移（VF）（7%对35%，p = 0.04）。对39例ⅡIC期和Ⅳ期疾病患者进行单独分析。与术后有任何残留疾病的患者相比，肿瘤细胞减灭术后无可见残留疾病的患者中位PFS（17个月对7个月，p < 0.001）和总生存期（OS）（40个月对18个月，p = 0.02）有显著改善。
采用系统性LND进行全面手术分期对于准确界定早期UCCC至关重要。对于经系统性LND确诊的Ⅰ期和Ⅱ期UCCC，阴道近距离放疗可能是充分的辅助治疗。有LF风险的患者似乎从盆腔放疗中获益。对于晚期UCCC，可行时应努力实现肿瘤细胞减灭至无可见残留疾病。
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