Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Tyne and Wear, United Kingdom.
Int J Gynecol Cancer. 2013 May;23(4):690-7. doi: 10.1097/IGC.0b013e31828c85c6.
Depth of myometrial invasion is considered as the strongest predictor of distant failure and death from disease in stage I endometrial cancer. The aim of this study was to determine whether tumor size (TS) is an independent prognostic indicator of survival and a better predictor than depth (%) of myometrial invasion, in stage I endometrioid endometrial cancer.
This was a retrospective study of all women with International Federation of Gynecology and Obstetrics stage I endometrioid endometrial carcinoma from January 2000 to December 2007, who had surgery at the Northern Gynaecological Oncology Centre. Surgicopathological, follow-up, and survival data were collected. Tumor size (a continuous variable) was defined as the maximum tumor dimension. Univariate and multivariate analyses to predict distant recurrence and death from disease were performed comparing known risk factors. The prognostic accuracy of TS was then assessed by receiver operating characteristic curve analyses, and an optimum cutoff was proposed.
A total of 216 women were identified. Pelvic lymphadenectomy was performed in 51 women (24%). The median follow-up time was 80 months (95% confidence interval [95% CI], 34-131 months), with 9 distant recurrences and 11 disease-related deaths. Tumor size was the only independent predictor of both distant recurrence (hazard ratio [HR], 1.05; 95% CI, 1.02-1.08; P = 0.004) and death from disease (HR, 1.03; 95% CI, 1.00-1.07; P = 0.05). Myometrial invasion only predicted distant failure (HR, 1.03, 95% CI, 1.00-1.05; P = 0.03). In women who did not have pelvic lymph node dissection (n = 165), only TS retained its independent prognostic value to predict both distant failure (HR, 1.08; 95% CI, 1.03-1.13; P = 0.002) and death from disease (HR, 1.05; 95% CI, 1.01-1.10; P = 0.02). In women who underwent pelvic lymphadenectomy, none of the variables predicted the above outcomes.
Tumor size could play a significant role in risk stratification and planning adjuvant treatment in women with International Federation of Gynecology and Obstetrics stage I endometrioid endometrial cancer.
子宫肌层浸润深度被认为是 I 期子宫内膜癌远处失败和疾病死亡的最强预测因素。本研究旨在确定肿瘤大小（TS）是否是生存的独立预后指标，并且比子宫肌层浸润深度（%）更好地预测 I 期子宫内膜样腺癌。
这是一项回顾性研究，纳入了 2000 年 1 月至 2007 年 12 月在北方妇科肿瘤中心接受手术治疗的所有国际妇产科联合会（FIGO）I 期子宫内膜样腺癌患者。收集了手术病理、随访和生存数据。肿瘤大小（连续变量）定义为最大肿瘤直径。通过比较已知的危险因素，进行单变量和多变量分析以预测远处复发和疾病死亡。然后通过接收者操作特征曲线分析评估 TS 的预后准确性，并提出最佳截断值。
共纳入 216 例患者。51 例（24%）患者行盆腔淋巴结切除术。中位随访时间为 80 个月（95%置信区间[95%CI]，34-131 个月），发生 9 例远处复发和 11 例疾病相关死亡。肿瘤大小是远处复发（风险比[HR]，1.05；95%CI，1.02-1.08；P=0.004）和疾病相关死亡（HR，1.03；95%CI，1.00-1.07；P=0.05）的唯一独立预测因素。子宫肌层浸润仅预测远处失败（HR，1.03，95%CI，1.00-1.05；P=0.03）。在未行盆腔淋巴结清扫术的 165 例患者中，仅 TS 保留了其独立的预后价值，可预测远处失败（HR，1.08；95%CI，1.03-1.13；P=0.002）和疾病相关死亡（HR，1.05；95%CI，1.01-1.10；P=0.02）。在接受盆腔淋巴结清扫术的患者中，没有一个变量预测以上结果。
肿瘤大小在国际妇产科联合会 I 期子宫内膜样腺癌患者的风险分层和辅助治疗计划中可能发挥重要作用。
