Department of Gynaecological Oncology, KK Gynaecological Cancer Centre, National Cancer Centre, Singapore, Singapore.
Int J Gynecol Cancer. 2010 May;20(4):564-9. doi: 10.1111/IGC.0b013e3181d7ce94.
Advanced age, deep myoinvasion, whole cavity or lower uterine segment tumors, poor differentiation, and lymphovascular space invasion are known to increase recurrence risk and adversely affect survival in stage I endometrioid adenocarcinoma of the uterus.
To ascertain survival rates, failure patterns, and salvageability and to correlate adverse histopathologic effects to recurrences in these patients.
Data of 162 patients with surgical stage I endometrioid adenocarcinoma of the uterus with an increased risk of recurrence were reviewed from the year 1997 to 2008 at KK Gynaecological Cancer Centre, Singapore. Each patient underwent surgical staging and histopathologic evaluation and received high-dose rate vaginal vault brachytherapy. The data of all patients were discussed in a multidisciplinary meeting.
The mean patient age was 58.9 years. Most patients (54.3%) had surgical stage IC endometrioid adenocarcinoma, whereas the rest had stage IB. Grade 2 tumors were seen in 53.7% of the patients and grade 3 in 21.61%. The mean follow-up duration was 52.9 months, with a maximum of 11.5 years. Five- and 10-year survival rates were 94% and 89%, respectively. There were 9 recurrences (5.56%). Stage IC had 77.78% recurrences, whereas stage IB had 22.22%, the median time being 19 months. The initial 3 years had 77.78% relapses. There was no recurrence in grade 3 tumors, with a 100% 5-year survival rate for stage IC grade 3. Age, lymphovascular space invasion, and tumor volume and location were not significant parameters in surgical stage I endometrioid adenocarcinoma patients who failed. One patient had isolated pelvic failure, whereas 5 had a pure distant relapse. Three patients failed at both locoregional and distant sites. Vault recurrence coupled with distant metastasis occurred in 1 patient. Three patients (33.33%) with recurrences, all with limited relapse sites, were salvaged, with a mean survival of 71.33 months. The median survival for recurrent endometrial cancer was 5 years.
This treatment has excellent survival rates with acceptable morbidity, and recurrence is mostly distant.
高龄、深层肌浸润、全腔或下段子宫肿瘤、低分化和脉管间隙浸润已知会增加复发风险，并对 I 期子宫内膜样腺癌的生存产生不利影响。
确定生存率、失败模式和挽救率，并将不良组织病理学效应与这些患者的复发相关联。
对 1997 年至 2008 年在新加坡 KK 妇科癌症中心接受手术治疗的 162 例具有较高复发风险的 I 期子宫内膜样腺癌患者的资料进行回顾性分析。每位患者均接受了手术分期和组织病理学评估，并接受了高剂量率阴道穹窿近距离放射治疗。所有患者的数据均在多学科会议上进行了讨论。
患者的平均年龄为 58.9 岁。大多数患者（54.3%）为手术 Ic 期子宫内膜样腺癌，其余为 Ib 期。2 级肿瘤占 53.7%，3 级肿瘤占 21.61%。平均随访时间为 52.9 个月，最长为 11.5 年。5 年和 10 年生存率分别为 94%和 89%。有 9 例复发（5.56%）。IC 期有 77.78%的复发，IB 期有 22.22%，中位时间为 19 个月。最初 3 年有 77.78%的复发。3 级肿瘤无复发，IC 级 3 级肿瘤 5 年生存率为 100%。在手术 I 期子宫内膜样腺癌患者中，年龄、脉管间隙浸润、肿瘤体积和位置并不是失败的显著参数。1 例患者仅有盆腔孤立性复发，5 例患者仅有单纯远处复发。3 例患者同时出现局部和远处复发。1 例患者出现穹窿复发伴远处转移。3 例（33.33%）复发患者均为局限性复发，且均接受了挽救性治疗，平均生存时间为 71.33 个月。复发性子宫内膜癌的中位生存时间为 5 年。
这种治疗方法具有极好的生存率和可接受的发病率，且复发主要为远处转移。
