Department of Gynecology and Obstetrics, S. Maria Goretti Hospital, Via G. Reni, 04100 Latina, Italy.
Arch Gynecol Obstet. 2012 Feb;285(2):521-7. doi: 10.1007/s00404-011-2004-9. Epub 2011 Jul 22.
The aim of this study was to determine whether a pre-intraoperative prognostic classification of endometrial cancer (EC) patients may accurately predict prognosis.
Prognostic factors achievable before and during surgery (histotype, grade, myoinvasion, cervical spread, abdominal spread) were utilized to classify patients in low-risk (endometrial adenocarcinoma, grade 1-2, myoinvasion <50%, no evidence of abdominal spread), and in intermediate/high risk (serous papillary and clear cell, grade 3, myoinvasion >50%, cervical invasion, abdominal spread). Risk classification obtained pre-intraoperatively was compared with the classification obtained from definitive surgical-pathological assessment in 130 consecutive patients with EC treated with surgery.
Pre-intraoperative risk assessment correctly identified risk classification in 125 (96%) patients; sensitivity, specificity, PPV and NPV were 98%, 94%, 94%, and 98%, respectively. Median follow-up was 38 months (range 6-93), and 14 (10%) patients relapsed (median time 14 months, range 3-60). Relative risk of relapse was higher in intermediate/high-risk patients with both classifications (pre-intraoperative RR 3.37, CI 0.99-11.5; surgical-pathological RR 4.56, CI 1.2-17.3). As regards survival 11 patients have died, 6 due to endometrial cancer and 5 due to intercurrent disease. Five-years DFS according to pre-intraoperative assessment was 89% and 71% for low-risk and intermediate high-risk patients (p = 0.028), respectively; according to definitive assessment was 91% and 70% for low-risk and intermediate/high-risk patients (p = 0.009), respectively.
This classification, giving an accurate risk and prognostic estimate with parameters routinely utilized in clinical practice, may help the surgeon when undertaking the decision to perform limited or extended surgical staging according to tumor and patient characteristics.
本研究旨在确定术前预后分类是否能准确预测子宫内膜癌（EC）患者的预后。
利用术前和术中可获得的预后因素（组织类型、分级、肌层浸润、宫颈扩散、腹部扩散）将患者分为低危组（子宫内膜腺癌，G1-2 级，肌层浸润<50%，无腹部扩散证据）和中高危组（浆液性乳头状和透明细胞癌，G3 级，肌层浸润>50%，宫颈浸润，腹部扩散）。对 130 例接受手术治疗的 EC 患者的术前风险分类与术后明确的手术病理评估进行比较。
术前风险评估正确识别了 125 例（96%）患者的风险分类；敏感性、特异性、PPV 和 NPV 分别为 98%、94%、94%和 98%。中位随访时间为 38 个月（6-93 个月），14 例（10%）患者复发（中位时间 14 个月，范围 3-60 个月）。两种分类的中高危患者复发的相对风险均较高（术前 RR 3.37，99%CI 0.99-11.5；手术病理 RR 4.56，1.2-17.3）。至于生存情况，有 11 例患者死亡，6 例死于子宫内膜癌，5 例死于并发疾病。根据术前评估，低危和中高危患者的 5 年 DFS 分别为 89%和 71%（p=0.028）；根据明确评估，低危和中高危患者的 5 年 DFS 分别为 91%和 70%（p=0.009）。
这种分类根据肿瘤和患者的特征，对参数进行常规应用，能准确评估风险和预后，有助于外科医生决定进行有限或广泛的手术分期。
