术前1级子宫内膜癌两种管理策略的评估。

Evaluation of two management strategies for preoperative grade 1 endometrial cancer.

作者信息

Bernardini Marcus Q, May Taymaa, Khalifa Mahmoud A, Bland Amy E, Nofech-Mozes Sharon, Berchuck Andrew, Covens Al, Havrilesky Laura

机构信息

From the Division of Gynaecologic Oncology, University Health Network, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Pathology and Division of Gynecologic Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada; and Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.

出版信息

Obstet Gynecol. 2009 Jul;114(1):7-15. doi: 10.1097/AOG.0b013e3181aa97fc.

DOI:10.1097/AOG.0b013e3181aa97fc

PMID:19546752

Abstract

OBJECTIVE

To compare the practices, adjuvant treatment, and outcomes of patients with preoperatively assessed grade 1 endometrioid endometrial cancer between two academic gynecologic oncology centers that use different treatment strategies.

METHODS

A retrospective analysis was performed at Duke University Medical Center (Duke) and the Toronto Sunnybrook Regional Cancer Center (Sunnybrook) between 1991 and 2007. Patients at Duke generally underwent surgical staging unless intraoperative assessment identified a negligible risk of nodal disease. Patients at Sunnybrook generally did not undergo surgical staging.

RESULTS

A total of 494 patients (272 from Duke and 222 from Sunnybrook were identified with preoperative, central-review-confirming, grade 1, endometrioid, endometrial cancer. Groups were similar in grade, final histology, type of hysterectomy, and length of hospital stay. Patients from Sunnybrook were older (aged 62 years compared with 59 years, P=.001) and were more likely to have capillary lymphatic space involvement (18.2% compared with 8.3%, P=.003) and cervical involvement (12.2% compared with 3.7%, P<.001). Approximately 2% of cases were upgraded to high grade on final specimen. Lymphadenectomy was performed on 49.4% of patients at Duke compared with 11.7% of patients at Sunnybrook. Overall 3-year survival was 96% at Duke and 96% at Sunnybrook (P=.217). Three-year recurrence-free survival was 96% at Duke and 95% at Sunnybrook (P=.327).

CONCLUSION

Despite differences in practice and slight differences in patient populations, the recurrence-free and overall survival of women with preoperative centrally reviewed grade 1 endometrial cancer is excellent and without statistically significant difference between the two centers.

LEVEL OF EVIDENCE

III

摘要

目的

比较两个采用不同治疗策略的学术性妇科肿瘤中心中术前评估为1级子宫内膜样子宫内膜癌患者的治疗方法、辅助治疗及治疗结果。

方法

1991年至2007年期间在杜克大学医学中心（杜克）和多伦多桑尼布鲁克地区癌症中心（桑尼布鲁克）进行了一项回顾性分析。杜克大学的患者一般接受手术分期，除非术中评估确定淋巴结疾病风险可忽略不计。桑尼布鲁克的患者一般不接受手术分期。

结果

共确定494例患者（杜克大学272例，桑尼布鲁克222例）术前经中心审查确诊为1级子宫内膜样子宫内膜癌。两组在分级、最终组织学、子宫切除类型和住院时间方面相似。桑尼布鲁克的患者年龄较大（62岁，而杜克大学为59岁，P = 0.001），更有可能出现毛细血管淋巴间隙受累（18.2%，而杜克大学为8.3%，P = 0.003）和宫颈受累（12.2%，而杜克大学为3.7%，P < 0.001）。约2%的病例在最终标本上升级为高级别。杜克大学49.4%的患者接受了淋巴结切除术，而桑尼布鲁克为11.7%。杜克大学的总体3年生存率为96%，桑尼布鲁克为96%（P = 0.217）。杜克大学的3年无复发生存率为96%，桑尼布鲁克为95%（P = 0.327）。