Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
Gynecol Oncol. 2012 Oct;127(1):32-7. doi: 10.1016/j.ygyno.2012.06.026. Epub 2012 Jun 24.
To evaluate the clinical outcomes for women with node-positive endometrioid adenocarcinoma of the uterus
Records were reviewed for 66 patients with Stage IIIC endometrioid adenocarcinoma diagnosed between 1/1995 and 12/2009. Study inclusion required TAH, BSO and negative chest imaging. Papillary serous and clear cell histologies were excluded. Adjuvant treatment was external beam radiation (RT) alone in 18 patients (27%), combined chemotherapy and RT in 44 (67%), chemotherapy alone in 1 (2%), and no adjuvant therapy in 3 (5%). The median follow-up was 48 months.
Of 66 patients, 56 (85%) had positive pelvic nodes only, 5 (8%) had positive para-aortic nodes only, and 5 (8%) had both. Of the 62 patients who received adjuvant RT, only 4 (6%) had an in-field recurrence, including 2 with residual disease after surgery. Disease-free (DFS) and overall (OS) survival rates at 5 years were 71% and 81%, respectively. By adjuvant treatment modality, 5-year DFS and OS rates were 63% and 67% for RT alone and 79% and 90% for combined modality therapy (p=0.15 and p<0.01). On multivariate analysis, combined modality therapy significantly improved DFS (HR 0.12, 95% CI 0.03-0.49, p<0.01) and OS (HR 0.20, 95% CI 0.05-0.75, p=0.02) compared to adjuvant RT alone.
Compared to RT alone, combined modality therapy decreased recurrence and improved survival in patients with node-positive endometrioid adenocarcinoma of the uterus. In addition, external beam RT resulted in excellent local and regional control. Future studies are needed to define the optimal chemotherapy regimen, sequencing, and radiation fields.
评估患有淋巴结阳性子宫内膜样腺癌的女性的临床结局。
回顾性分析了 1995 年 1 月至 2009 年 12 月期间诊断为 IIIC 期子宫内膜样腺癌的 66 例患者的记录。研究纳入标准为行全子宫切除术（TAH）、双侧附件切除术（BSO）和阴性胸部影像学检查。排除乳头状浆液性和透明细胞组织学类型。18 例（27%）患者接受单纯外照射放疗（RT），44 例（67%）患者接受化疗联合 RT，1 例（2%）患者接受单纯化疗，3 例（5%）患者未接受辅助治疗。中位随访时间为 48 个月。
66 例患者中，56 例（85%）仅盆腔淋巴结阳性，5 例（8%）仅腹主动脉旁淋巴结阳性，5 例（8%）盆腔和腹主动脉旁淋巴结均阳性。在接受辅助 RT 的 62 例患者中，仅有 4 例（6%）发生了野内复发，其中 2 例在手术后有残留疾病。5 年无病生存率（DFS）和总生存率（OS）分别为 71%和 81%。按辅助治疗方式，单纯 RT 组的 5 年 DFS 和 OS 率分别为 63%和 67%，联合治疗组为 79%和 90%（p=0.15 和 p<0.01）。多因素分析显示，与单纯 RT 相比，联合治疗显著改善了 DFS（HR 0.12，95%CI 0.03-0.49，p<0.01）和 OS（HR 0.20，95%CI 0.05-0.75，p=0.02）。
与单纯 RT 相比，联合治疗可降低淋巴结阳性子宫内膜样腺癌患者的复发率并提高生存率。此外，外照射 RT 可获得良好的局部和区域控制效果。未来需要研究来确定最佳的化疗方案、顺序和放疗野。
