Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA.
Int J Gynecol Cancer. 2012 Mar;22(3):417-24. doi: 10.1097/IGC.0b013e31823c6e36.
The aim of this retrospective, multi-institutional study was to evaluate the importance of surgical staging for stage I uterine papillary serous carcinomas (UPSCs) to determine optimal management of this rare tumor.
With institutional review board approval from both participating institutions, all patients with 2009 International Federation of Gynecology and Obstetrics stage I mixed serous and UPSC diagnosed between January 1, 1992, and December 31, 2007, were identified at the 2 institutions. Clinical factors were correlated using Spearman correlation coefficients, Kaplan-Meier survival estimates and a Cox proportional hazards model.
Of the 204 UPSC patients treated during this period, 84 were classified as stage I, with substages as follows: stage IA, n = 71; stage IB, n = 13. Thirty-seven patients (44%) had a history of a second cancer (22 breast tumors, 9 synchronous müllerian cancers). Surgical staging with at least hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and bilateral pelvic lymph node dissection was performed in 60 (71%) of 84 patients. The median survival for all patients was 10 years. Univariate analysis revealed surgical staging (P < 0.001), normal preoperative CA-125 (P < 0.001), and absence of additional cancers (P < 0.01) to be associated with improved survival. Age-adjusted multivariate analysis incorporating these factors revealed that advancing substage (hazard ratio, 4.59; P < 0.05), a second malignancy (hazard ratio, 2.75; P < 0.04), and surgical staging (hazard ratio, 0.18; P < 0.001) were independent factors associated with overall survival. In a subset analysis excluding patients with a second malignancy, substage (hazard ratio, 3.52; P < 0.05), and surgical staging (hazard ratio, 0.16; P < 0.001) were independent factors affecting overall survival.
Independent of adjuvant chemotherapy or radiation, stage of disease, comprehensive surgical staging, and the presence of a second malignancy were predictors of overall survival.
本回顾性多机构研究旨在评估手术分期对 I 期子宫乳头状浆液性癌（UPSC）的重要性，以确定对这种罕见肿瘤的最佳治疗方法。
经两家参与机构的机构审查委员会批准，在这两家机构中确定了 1992 年 1 月 1 日至 2007 年 12 月 31 日期间被诊断为 2009 年国际妇产科联合会（FIGO）I 期混合性浆液性和 UPSC 的所有患者。采用 Spearman 相关系数、Kaplan-Meier 生存估计和 Cox 比例风险模型对临床因素进行相关性分析。
在这一时期治疗的 204 例 UPSC 患者中，84 例被归类为 I 期，亚期如下：IA 期，n = 71；IB 期，n = 13。37 例（44%）有第二原发癌病史（22 例乳腺癌，9 例同步 Müllerian 癌）。60 例（71%）患者接受了至少包括子宫切除术、双侧输卵管卵巢切除术、网膜切除术和双侧盆腔淋巴结清扫术的手术分期。所有患者的中位生存时间为 10 年。单因素分析显示，手术分期（P < 0.001）、术前 CA-125 正常（P < 0.001）和无其他癌症（P < 0.01）与生存改善相关。包含这些因素的年龄调整多因素分析显示，亚期进展（危险比，4.59；P < 0.05）、第二恶性肿瘤（危险比，2.75；P < 0.04）和手术分期（危险比，0.18；P < 0.001）是与总生存相关的独立因素。在排除有第二恶性肿瘤的患者的亚组分析中，亚期（危险比，3.52；P < 0.05）和手术分期（危险比，0.16；P < 0.001）是影响总生存的独立因素。
独立于辅助化疗或放疗，疾病分期、全面的手术分期和第二恶性肿瘤的存在是总生存的预测因素。
