Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.
Int J Gynecol Pathol. 2013 Mar;32(2):181-7. doi: 10.1097/PGP.0b013e318273fc55.
The objective of this study was to analyze the clinical and pathologic factors in patients with uterine serous carcinoma confined to the endometrium. A total of 236 uterine serous carcinoma patients from the pathology databases of 4 large academic institutions were included in the study. Clinical and pathologic variables were analyzed, including patient demographics, tumor size (≤2 vs. >2 cm), myometrial invasion, lymphovascular invasion, lymph node status, tumor location (endometrium vs. polyp), cervical involvement, lower uterine segment involvement, FIGO stage, pelvic washings, recurrence, overall survival, and progression-free survival. Of 236 patients, 55 (23%) had tumors limited to the endometrium. Forty-four patients (80%) had Stage IA tumors. The tumor was confined to a polyp in 17 (30.9%) patients. Twenty patients (36.4%) had tumor sizes >2 cm and 12 (21.8%) exhibited lymphovascular invasion. Only 3 patients (5.4 %) had cervical stromal involvement. Thirty-three (66%) patients underwent pelvic and para-aortic lymphadenectomy with 2 positive para-aortic lymph nodes identified. Seven (12.7%) patients had positive washings, whereas 8 patients (14.5 %) had disease recurrence. At a median follow-up of 46 months, there was no difference in overall survival (P = 0.216) or progression-free survival (P=0.063) between patients with tumors confined to a polyp, patients with tumors confined to the endometrium, and patients with tumors present in both polyp and the endometrium. Uterine serous carcinoma with only endometrial involvement, even when confined to a polyp, can be associated with poor prognosis, further stressing the importance of complete surgical staging and adjuvant treatment in this setting.
本研究旨在分析局限于子宫内膜的子宫浆液性癌患者的临床病理因素。本研究纳入了来自 4 家大型学术机构病理数据库的 236 名子宫浆液性癌患者。分析了临床和病理变量，包括患者人口统计学、肿瘤大小（≤2 厘米与>2 厘米）、肌层浸润、脉管侵犯、淋巴结状态、肿瘤位置（子宫内膜与息肉）、宫颈受累、下段子宫受累、FIGO 分期、盆腔冲洗液、复发、总生存期和无进展生存期。在 236 名患者中，55 名（23%）的肿瘤局限于子宫内膜。44 名（80%）患者为 IA 期肿瘤。肿瘤局限于息肉的有 17 名（30.9%）患者。20 名（36.4%）患者的肿瘤大小>2 厘米，12 名（21.8%）患者存在脉管侵犯。仅有 3 名患者（5.4%）存在宫颈间质受累。33 名（66%）患者行盆腔和腹主动脉旁淋巴结切除术，其中 2 名患者腹主动脉旁淋巴结阳性。7 名（12.7%）患者的盆腔冲洗液阳性，8 名（14.5%）患者出现疾病复发。在中位随访 46 个月时，局限于息肉、局限于子宫内膜和息肉与子宫内膜均有肿瘤的患者之间，总生存期（P=0.216）或无进展生存期（P=0.063）无差异。仅局限于子宫内膜的子宫浆液性癌，即使局限于息肉，也可能预后不良，这进一步强调了在这种情况下进行全面手术分期和辅助治疗的重要性。
