Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Via Roma 56, Pisa 56127, Italy.
Anticancer Res. 2011 Oct;31(10):3483-8.
The aim of this study was to assess the pattern of failure and the outcome of endometrial cancer patients and to analyze the variables predictive of the risk of local, distant and retroperitoneal lymph node disease recurrence.
The authors assessed 511 patients who underwent primary surgery. The median follow-up of survivors was 74 months. Peritoneal, hematogenous and lymph node recurrences outside retroperitoneal area were considered as distant failures.
Tumor relapsed in 83 (16.2%) patients. Median time to recurrence was 18.5 months (range, 3-129 months). The relapse was local in 13 cases, distant in 37, retroperitoneal in 22, and involved both distant and other sites in 11. Logistic regression showed that cervical involvement was the only independent predictor of local recurrence. Tumor grade, lymph-vascular space involvement (LVSI) and myometrial invasion were independent predictors of distant failure. Lymph node status and tumor grade were independent predictors of retroperitoneal recurrence. Five- and 10-year overall survival rates were 87.1% and 79.5%, respectively. Patient age, lymph node status, cervical involvement, tumor grade, LVSI and myometrial invasion were independent prognostic variables for overall survival.
Cervical involvement was an independent predictor of local recurrence, LVSI and myometrial invasion were independent predictors of distant failure, lymph node status was an independent predictor of retroperitoneal relapse, and tumor grade was an independent predictor of both distant and retroperitoneal recurrence. The identification of risk factors for different patterns of failure can be useful in better tailoring adjuvant treatment.
本研究旨在评估子宫内膜癌患者的失败模式和结局，并分析预测局部、远处和腹膜后淋巴结疾病复发风险的变量。
作者评估了 511 例接受初次手术的患者。幸存者的中位随访时间为 74 个月。腹膜、血液和腹膜后区域以外的淋巴结复发被认为是远处失败。
83 例（16.2%）患者肿瘤复发。中位复发时间为 18.5 个月（范围 3-129 个月）。13 例为局部复发，37 例为远处复发，22 例为腹膜后复发，11 例同时累及远处和其他部位。逻辑回归显示，宫颈受累是局部复发的唯一独立预测因素。肿瘤分级、脉管间隙浸润（LVSI）和肌层浸润是远处失败的独立预测因素。淋巴结状态和肿瘤分级是腹膜后复发的独立预测因素。5 年和 10 年总生存率分别为 87.1%和 79.5%。患者年龄、淋巴结状态、宫颈受累、肿瘤分级、LVSI 和肌层浸润是总生存的独立预后因素。
宫颈受累是局部复发的独立预测因素，LVSI 和肌层浸润是远处失败的独立预测因素，淋巴结状态是腹膜后复发的独立预测因素，肿瘤分级是远处和腹膜后复发的独立预测因素。确定不同失败模式的危险因素有助于更好地调整辅助治疗。
