Fader Amanda Nickles, Starks David, Gehrig Paola A, Secord Angeles Alvarez, Frasure Heidi E, O'Malley David M, Tuller Erin R, Rose Peter G, Havrilesky Laura J, Moore Kathleen N, Huh Warner K, Axtell Allison E, Kelley Joseph L, Zanotti Kristine M
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Cleveland Clinic, Cleveland, OH, USA.
Gynecol Oncol. 2009 Nov;115(2):244-8. doi: 10.1016/j.ygyno.2009.07.030. Epub 2009 Aug 26.
Stage I-II uterine papillary serous carcinoma (UPSC) patients have a significant risk for extrapelvic recurrence. However, clinicopathologic risk factors for recurrence are not well understood. This study was undertaken to define the prognostic factors for recurrence and survival in patients with early-stage UPSC.
A retrospective, multi-institution analysis of surgically staged I-II UPSC patients was performed. Patients were treated by various adjuvant modalities. Age, race, sub-stage, percentage UPSC histology, lymphvascular space invasion (LVSI), tumor size and adjuvant treatment modality were evaluated for their effect on recurrence and survival outcomes.
We identified 206 patients. Forty patients (19.4%) had 5-49% UPSC, 55 (26.7%) had 50-99% and 111 patients (53.9%) had 100% UPSC in their respective uterine specimens. Twenty one percent of patients experienced a primary recurrence. On univariate analysis, age, increasing %UPSC, LVSI, and tumor size were not significantly associated with recurrence or progression-free survival (PFS). However, substage (p=0.005) and treatment with platinum/taxane-based chemotherapy (p=0.001) were associated with recurrence/PFS. On multivariate analysis, only chemotherapy (p=0.01) was a significant factor affecting PFS, whereas age (p=0.05), substage (p=0.05), and chemotherapy (p=0.02) were associated with overall survival.
Traditional risk factors for recurrence and survival in patients with early-stage endometrial cancer may not be relevant in patients with UPSC. Patients with any percentage UPSC in their uterine specimens are at a significant risk for recurrence and poor survival outcomes. Given that current clinicopathologic data does not accurately identify women most likely to benefit from adjuvant therapy, alternative prognostic markers based on novel techniques should be explored.
Ⅰ-Ⅱ期子宫浆液性乳头状癌（UPSC）患者有盆腔外复发的显著风险。然而，复发的临床病理危险因素尚未完全明确。本研究旨在确定早期UPSC患者复发和生存的预后因素。
对手术分期为Ⅰ-Ⅱ期的UPSC患者进行多机构回顾性分析。患者接受了多种辅助治疗方式。评估年龄、种族、亚分期、UPSC组织学百分比、淋巴管间隙浸润（LVSI）、肿瘤大小和辅助治疗方式对复发和生存结局的影响。
我们共纳入206例患者。在各自的子宫标本中，40例患者（19.4%）的UPSC占5%-49%，55例（26.7%）占50%-99%，111例患者（53.9%）的UPSC占100%。21%的患者出现原发复发。单因素分析显示，年龄、UPSC百分比增加、LVSI和肿瘤大小与复发或无进展生存期（PFS）无显著相关性。然而，亚分期（p=0.005）和铂类/紫杉类化疗（p=0.001）与复发/PFS相关。多因素分析显示，只有化疗（p=0.01）是影响PFS的显著因素，而年龄（p=0.05）、亚分期（p=0.05）和化疗（p=0.02）与总生存期相关。
早期子宫内膜癌患者复发和生存的传统危险因素可能与UPSC患者无关。子宫标本中任何百分比的UPSC患者都有显著的复发风险和较差的生存结局。鉴于目前的临床病理数据不能准确识别最可能从辅助治疗中获益的女性，应探索基于新技术的替代预后标志物。
