优化II期子宫内膜癌的管理：根治性子宫切除术和放疗的作用。
Optimizing the management of stage II endometrial cancer: the role of radical hysterectomy and radiation.
作者信息
Wright Jason D, Fiorelli Jessica, Kansler Amanda L, Burke William M, Schiff Peter B, Cohen Carmel J, Herzog Thomas J
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
出版信息
Am J Obstet Gynecol. 2009 Apr;200(4):419.e1-7. doi: 10.1016/j.ajog.2008.11.003. Epub 2009 Jan 10.
OBJECTIVE
The optimal management of stage II endometrial cancer remains uncertain. We examined the role of radical hysterectomy and adjuvant radiotherapy for stage II endometrial cancer.
STUDY DESIGN
The Surveillance, Epidemiology, and End Results database was used to identify 1577 women with stage II endometrioid type endometrial adenocarcinoma who underwent surgical staging.
RESULTS
The cohort included 1198 women who underwent simple hysterectomy (76%) and 379 who underwent radical hysterectomy (24%). Radical hysterectomy had no effect on survival (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.61-1.23). Patients who did not receive radiation were 48% (HR, 1.48; 95% CI, 1.14-1.93) more likely to die than those who underwent adjuvant radiotherapy. The survival benefit from radiation was most pronounced in women who underwent radical hysterectomy.
CONCLUSION
Adjuvant radiation improves survival. Although the routine performance of radical hysterectomy does not appear to be justified, patients with high-risk stage II tumors appear to benefit from combination therapy with radical hysterectomy and radiotherapy.
目的
II期子宫内膜癌的最佳治疗方案仍不明确。我们研究了根治性子宫切除术及辅助放疗在II期子宫内膜癌治疗中的作用。
研究设计
利用监测、流行病学与最终结果数据库，确定了1577例接受手术分期的II期子宫内膜样型子宫内膜腺癌女性患者。
结果
该队列包括1198例行单纯子宫切除术的女性（76%）和379例行根治性子宫切除术的女性（24%）。根治性子宫切除术对生存率无影响（风险比[HR]，0.86；95%置信区间[CI]，0.61 - 1.23）。未接受放疗的患者死亡可能性比接受辅助放疗的患者高48%（HR，1.48；95% CI，1.14 - 1.93）。放疗带来的生存获益在接受根治性子宫切除术的女性中最为显著。
结论
辅助放疗可提高生存率。虽然根治性子宫切除术的常规实施似乎并无依据，但高危II期肿瘤患者似乎可从根治性子宫切除术与放疗的联合治疗中获益。
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