Nemani Deepika, Mitra Nandita, Guo Mengye, Lin Lilie
Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
Gynecol Oncol. 2008 Oct;111(1):82-8. doi: 10.1016/j.ygyno.2008.05.016.
The purpose of this analysis is to determine the pathologic prognostic factors and treatment outcome of patients with carcinosarcoma of the uterus.
A retrospective analysis of data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute between January 1, 1988 and November 1, 2003 was conducted. A total of 1855 with AJCC Stages I-III disease were identified who received primary surgical treatment. Overall survival curves were constructed using Kaplan-Meier curves. Cox proportional hazards model was used to identify factors predictive of overall survival.
AJCC stage of all patients was as follows: 65% Stage I (n=1099), 14% Stage II (n=245), 21% Stage III (n=353). 57% (n=965) patients underwent LND. The median number of lymph nodes removed was 12 (SD=10.2); 119 (14%) patients had positive lymph nodes. Five-year overall survival (OS), disease free survival, and median survival were significantly improved for patients receiving lymph node dissection (LND) as compared to patients that received no LND, irrespective of radiotherapy. Adjuvant radiation therapy had no improvement on overall survival regardless of LND. There was no overall survival benefit to the addition of radiotherapy regardless of whether patients underwent a lymph node dissection or not. Age, race, marital status, lymph node dissection and stage were predictive of survival on multivariate analysis.
Lymphadenectomy is significantly associated with improved overall survival in patients with Stage I-III uterine carcinosarcoma compared to no lymphadenectomy. The use of adjuvant radiotherapy conferred no overall survival benefit.
本分析旨在确定子宫癌肉瘤患者的病理预后因素及治疗结果。
对美国国立癌症研究所监测、流行病学和最终结果计划在1988年1月1日至2003年11月1日期间的数据进行回顾性分析。共确定1855例接受了初次手术治疗的AJCC I - III期疾病患者。使用Kaplan - Meier曲线构建总生存曲线。采用Cox比例风险模型确定总生存的预测因素。
所有患者的AJCC分期如下：65%为I期（n = 1099），14%为II期（n = 245），21%为III期（n = 353）。57%（n = 965）的患者接受了淋巴结清扫术（LND）。切除淋巴结的中位数为12个（标准差 = 10.2）；119例（14%）患者有阳性淋巴结。与未接受LND的患者相比，无论是否接受放疗，接受淋巴结清扫术（LND）的患者的五年总生存（OS）、无病生存和中位生存均有显著改善。辅助放疗无论是否进行LND，对总生存均无改善。无论患者是否接受淋巴结清扫术，增加放疗均无总生存获益。年龄、种族、婚姻状况、淋巴结清扫术和分期在多因素分析中是生存的预测因素。
与未进行淋巴结清扫相比，I - III期子宫癌肉瘤患者进行淋巴结切除术与总生存改善显著相关。辅助放疗未带来总生存获益。
