Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
Ann Surg Oncol. 2010 Apr;17(4):1111-7. doi: 10.1245/s10434-009-0892-8.
Incidence of endometrial carcinoma, the most common malignancy of the female pelvis, has been steadily increasing during the last three decades. The prognosis for stage IVb cases with extra-abdominal metastases is extremely poor, with no current consensus regarding treatment. The aim of the present study was to examine the benefits of cytoreductive surgery for such cases.
Clinicopathological features of 33 stage IVb cases of endometrial carcinoma diagnosed during the 1991-2008 study period were retrospectively reviewed utilizing clinical records. Cytoreduction was conducted in 30 cases.
The median progression-free survival (PFS) and overall survival (OS) of those patients with optimal cytoreduction of their disease (with residual masses < or =2 cm), were significantly better than those with suboptimal reduction (with residual masses > 2 cm), not only among the 15 stage IVb patients with only intra-abdominal metastasis (group I) (P = 0.0003 and 0.0007) but also among the 15 cases with extra-abdominal metastasis (group E) (P = 0.013 and 0.016). Multivariate Cox proportional-hazards analysis demonstrated that the adjusted hazard ratio (HR) for the maximum size of residual disease (>2 vs. < or =2 cm) was 10.4 [95% confidence interval (CI), 1.27-84.70, P = 0.030] in group I and 16.92 (95% CI, 1.41-203.09, P = 0.026) in group E.
This is the first demonstration that aggressive cytoreductive surgery for stage IVb endometrial carcinoma with extra-abdominal metastasis has a beneficial role. However, further investigation is still required to establish better standard therapy for stage IVb endometrial cancer.
子宫内膜癌是女性盆腔最常见的恶性肿瘤，在过去三十年中其发病率一直在稳步上升。对于有腹腔外转移的 IVB 期病例，其预后极差，目前尚无治疗共识。本研究旨在探讨对此类病例进行细胞减灭术的益处。
回顾性分析 1991 年至 2008 年期间诊断的 33 例 IVB 期子宫内膜癌病例的临床病理特征，利用临床记录进行研究。对 30 例患者进行了细胞减灭术。
疾病最佳减瘤（残余病灶<或=2cm）患者的无进展生存（PFS）和总生存（OS）中位数明显优于次优减瘤（残余病灶>2cm）患者，不仅在仅存在腹腔内转移的 15 例 IVB 患者（组 I）中（P=0.0003 和 0.0007），而且在存在腹腔外转移的 15 例患者（组 E）中也是如此（P=0.013 和 0.016）。多变量 Cox 比例风险分析表明，最大残余肿瘤尺寸（>2cm 与<或=2cm）的调整后的危险比（HR）在组 I 中为 10.4[95%置信区间（CI），1.27-84.70，P=0.030]，在组 E 中为 16.92（95% CI，1.41-203.09，P=0.026）。
这是首次证明对于有腹腔外转移的 IVB 期子宫内膜癌进行积极的细胞减灭术具有有益作用。然而，仍需要进一步的研究来为 IVB 期子宫内膜癌建立更好的标准治疗。
