Gadducci Angiolo, Cavazzana Andrea, Cosio Stefania, DI Cristofano Claudio, Tana Roberta, Fanucchi Antonio, Teti Giancarlo, Cristofani Renza, Genazzani Andrea Riccardo
Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Via Roma 56, Pisa 56127, Italy.
Anticancer Res. 2009 May;29(5):1715-20.
The aim of this retrospective study was to assess the predictive value of different clinicopathological variables (patient age, tumour size, FIGO grade, myometrial invasion, lymph-vascular space involvement [LVSI], invasion margins, peri-tumour phlogistic infiltrate and mitotic activity) for the risk of distant haematogenous recurrences in patients with endometrioid-type stage Ib-II endometrial cancer. Between August 1990 and April 2005, 259 patients had undergone laparotomy, peritoneal washing, total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without pelvic +/- para-aortic lymphadenectomy for endometrioid-type endometrial cancer. Thirty-six (13.9%) patients had developed recurrent disease after a median time of 17 months (range, 2-128 months). The relapse had been locoregional in 9, distant in 21 and both locoregional plus distant in 6 cases. This study assessed 12 patients with FIGO stage Ib-II disease who had developed distant haematogenous recurrences and 20 randomly chosen control patients with FIGO stage Ib-II disease who had remained recurrence-free after a median follow-up of 52 months (range, 37-66 months). Adjuvant therapy had been: no further treatment in 15 patients, external pelvic irradiation in 14 patients, adjuvant external pelvic irradiation plus brachytherapy in 2 patients and platinum-based chemotherapy followed by external pelvic irradiation in 1 patient. The site of distant failure had been the lung in 9 patients, liver in 2 patients and lung plus liver in 1 patient. A concomitant locoregional relapse (vagina or lymph nodes) had occurred in 3 patients. The median interval between surgery and the development of distant failure had been 16.5 months (range, 5-113 months). On univariate analysis, a higher incidence of FIGO grade 3 (50% versus 10%, p=0.0114), outer one-third myometrial invasion (91.7% versus 35.0%, p=0.0051) and LVSI (75.0.% versus 20.0%, p=0.0022) was found in the patients who had developed distant haematogeneous metastases compared to the recurrence-free women. Multivariate analysis showed that LVSI (p=0.0264) and deep myometrial invasion (p=0.0345) were independent predictive variables for the risk of distant haematogeneous failure. Patients with these pathological findings should be enrolled in randomised trials designed to assess the role of adjuvant chemotherapy alone or combined with sequential and/or concomitant external pelvic irradiation.
本回顾性研究的目的是评估不同临床病理变量（患者年龄、肿瘤大小、国际妇产科联盟[FIGO]分级、肌层浸润、淋巴管间隙受累[LVSI]、浸润边缘、肿瘤周围炎性浸润和有丝分裂活性）对子宫内膜样Ib-II期子宫内膜癌患者远处血行复发风险的预测价值。1990年8月至2005年4月期间，259例患者因子宫内膜样子宫内膜癌接受了剖腹手术、腹腔冲洗、全腹子宫切除术和双侧输卵管卵巢切除术，部分患者进行了或未进行盆腔和/或腹主动脉旁淋巴结清扫术。36例（13.9%）患者在中位时间17个月（范围2 - 128个月）后出现复发疾病。其中9例为局部区域复发，21例为远处复发，6例为局部区域和远处均复发。本研究评估了12例FIGO Ib-II期发生远处血行复发的患者以及20例随机选择的FIGO Ib-II期无复发的对照患者，中位随访时间为52个月（范围37 - 66个月）。辅助治疗情况如下：15例患者未接受进一步治疗，14例患者接受盆腔外照射，2例患者接受盆腔外照射加近距离放疗，1例患者接受铂类化疗后再行盆腔外照射。远处转移部位为：9例患者为肺，2例患者为肝，1例患者为肺和肝。3例患者同时出现局部区域复发（阴道或淋巴结）。手术至远处转移发生的中位间隔时间为16.5个月（范围5 - 113个月）。单因素分析发现，与无复发的女性相比，发生远处血行转移的患者中FIGO 3级（50%对10%，p = 0.0114）、肌层外三分之一浸润（91.7%对35.0%，p = 0.0051）和LVSI（75.0%对20.0%，p = 0.0022）的发生率更高。多因素分析显示，LVSI（p = 0.0264）和肌层深部浸润（p = 0.0345）是远处血行转移风险的独立预测变量。具有这些病理表现的患者应纳入随机试验，以评估单纯辅助化疗或联合序贯和/或同步盆腔外照射的作用。
