Tchabo Nana E, McCloskey Susan, Mashtare Terry L, Andrews Christopher, Singh Anurag K, Mhawech-Fauceglia Paulette, Odunsi Kunle, Lele Shashikant, Jaggernauth Wainwright
Division of Gynecologic Oncology, Department of Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
Gynecol Oncol. 2009 Nov;115(2):249-56. doi: 10.1016/j.ygyno.2009.07.004. Epub 2009 Aug 18.
Optimal management of early-stage uterine papillary serous carcinoma (UPSC) remains controversial. We reviewed our outcomes in this patient population.
The Roswell Park Cancer Institute (RPCI) tumor registry identified all patients with Stages I and IIA UPSC treated between January 1992 and June 2006. The Fisher's exact test was used to compare recurrence rates by adjuvant therapy received. Overall survival (OS) estimates were made using the Kaplan-Meier method.
Fifty-eight patients with Stage I or IIA UPSC underwent surgery. Thirty-four patients (59%) were surgically staged. Among 21 patients with Stage IA disease, 15 received adjuvant therapy. With a median follow-up of 44.7 months, only one recurrence was observed in a patient who received adjuvant brachytherapy. The 5-year OS was 66%. Among 37 patients with Stages IB-IIA, 30 patients received adjuvant therapy. With a median follow-up of 29 months, there were 7 recurrences. The 5-year OS was 60%. Although there were no significant differences in recurrence by adjuvant therapy received, a significant OS benefit was found in those who received radiation. There was no significant difference in OS distributions of those patients who received Carboplatin/Paclitaxel chemotherapy.
Despite the limitations of our retrospective study, we have shown that even comprehensively staged early-stage UPSC patients are still at risk for recurrence despite adjuvant therapy received. Hence, all patients with this histologic diagnosis should be considered at high risk for recurrence and counseled appropriately regarding the risks and benefits of adjuvant therapy.
早期子宫浆液性乳头状癌（UPSC）的最佳治疗方案仍存在争议。我们回顾了该患者群体的治疗结果。
罗斯韦尔帕克癌症研究所（RPCI）肿瘤登记处确定了1992年1月至2006年6月期间接受治疗的所有Ⅰ期和ⅡA期UPSC患者。采用Fisher精确检验比较接受辅助治疗后的复发率。使用Kaplan-Meier方法进行总生存（OS）估计。
58例Ⅰ期或ⅡA期UPSC患者接受了手术。34例患者（59%）进行了手术分期。在21例ⅠA期疾病患者中，15例接受了辅助治疗。中位随访44.7个月，仅1例接受辅助近距离放疗的患者出现复发。5年总生存率为66%。在37例ⅠB-ⅡA期患者中，30例接受了辅助治疗。中位随访29个月，有7例复发。5年总生存率为60%。尽管接受辅助治疗后的复发率无显著差异，但接受放疗的患者总生存有显著获益。接受卡铂/紫杉醇化疗的患者的总生存分布无显著差异。
尽管我们的回顾性研究存在局限性，但我们已经表明，即使是全面分期的早期UPSC患者，尽管接受了辅助治疗，仍有复发风险。因此，所有组织学诊断为此病的患者都应被视为复发高危患者，并应就辅助治疗的风险和益处给予适当的咨询。
