Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
Int J Gynecol Cancer. 2012 Jul;22(6):1013-9. doi: 10.1097/IGC.0b013e31825ad3ee.
To determine current practice and to assess the value of routine follow-up procedures for endometrial cancer surveillance. To discuss whether such procedures are feasible and effective to identify asymptomatic recurrences and describe the pattern of relapse detected by procedures.
The records of 282 consecutive women with recurrent endometrial cancer treated from 1986 to 2005 were retrospectively collected in 8 Italian institutions. Primary disease, clinical history, and recurrence features and data were analyzed.
Thirty-five (12.4%) of 282 patients had recurrence in vaginal vault, 51 patients (18.0%) had recurrence in central pelvis, 14 patients (4.9%) had recurrence in pelvic wall, and 39 patients (13.8%) had recurrence in lymph nodes. One-hundred twenty-eight patients (45.3%) showed a distant relapse, whereas 15 patients (5.3%) developed both distant relapse and local relapse. The site of relapse influenced survival because the patients with vaginal vault recurrences lived significantly longer than the patients with recurrences in other sites. Eighty (28.4%) of the 282 patients became symptomatic and anticipated the scheduled visit, 37 (13.1 %) of the patients reported their symptoms during the follow-up meeting, and 165 (58.5 %) of the patients were asymptomatic and the diagnostic path was introduced by a planned visit or examination. Among the asymptomatic patients, the first procedure that led to further examinations was clinical visit alone for 60 (36.4%) of 165 patients, imaging for 103 patients (62.4%), and cytologic examination for 2 patients (1.2%). Symptoms at recurrence can predict survival: patients with an asymptomatic recurrence had a median survival time from relapse of 35 months versus 13 months if they had a symptomatic repetition (P = 0.0001).
Follow-up after endometrial cancer treatment varies in Italy. In this retrospective study, women with asymptomatic recurrence have shown a better clinical outcome compared with those with symptomatic relapse. The optimal approach is actually unknown, and guidelines comparing follow-up protocols have not been established. Prospective cost-effectiveness studies are needed.
确定目前的实践，并评估子宫内膜癌监测的常规随访程序的价值。讨论这些程序是否可行和有效，以确定无症状复发，并描述通过程序检测到的复发模式。
回顾性收集了 1986 年至 2005 年 8 家意大利机构治疗的 282 例复发性子宫内膜癌患者的连续记录。分析了主要疾病、临床病史、复发特征和数据。
282 例患者中，35 例（12.4%）阴道穹窿复发，51 例（18.0%）中央骨盆复发，14 例（4.9%）盆腔壁复发，39 例（13.8%）淋巴结复发。128 例（45.3%）患者出现远处复发，15 例（5.3%）患者同时出现远处和局部复发。复发部位影响生存，因为阴道穹窿复发的患者比其他部位复发的患者生存时间明显更长。282 例患者中，80 例（28.4%）有症状并预期预约就诊，37 例（13.1%）患者在随访时报告了症状，165 例（58.5%）患者无症状，诊断路径由计划就诊或检查引入。在无症状患者中，导致进一步检查的第一个程序是 60 例（36.4%）患者单独进行临床检查，103 例（62.4%）患者进行影像学检查，2 例（1.2%）患者进行细胞学检查。复发时的症状可以预测生存：无症状复发患者的中位生存时间从复发起为 35 个月，而有症状复发的患者为 13 个月（P=0.0001）。
意大利的子宫内膜癌治疗后随访方式不同。在这项回顾性研究中，无症状复发的女性与有症状复发的女性相比，临床结局更好。最佳方法实际上是未知的，也没有制定比较随访方案的指南。需要进行前瞻性成本效益研究。
