Department of Gynecological Oncology, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):309-16. doi: 10.1016/j.ejogrb.2013.02.025. Epub 2013 Mar 27.
To identify independent prognostic variables for surgically staged intermediate risk endometrial carcinoma as defined by the Gynecologic Oncology Group 99 (GOG99) criteria.
Retrospective study of 239 patients with FIGO stage IB-occult IIB endometrioid type endometrial cancer, who were primarily treated with comprehensive staging surgery. Data were collected on clinicopathological variables, extent of primary surgery, postoperative adjuvant treatment, and patterns of recurrences. Kaplan-Meier survival curves were used to estimate disease free survival (DFS) and overall survival (OS), and multivariate Cox regression models were used to identify independent prognostic variables. The median follow-up time was 67 months (range, 12-183 months).
The 5-year DFS and OS were 91.0% and 93.0%, respectively. On univariate Kaplan-Meier analysis, age>60 years, deep myometrial invasion (MI), presence of lymph vascular invasion (LVSI), and negative progesterone receptor (PR) status were significantly associated with diminished 5-year DFS and OS. The univariate analysis on patterns of failures demonstrated that patients with older age or positive LVSI were more inclined to develop locoregional recurrence, while PR status and the depth of MI had a statistically significant impact on distant failure. On multivariate analysis, PR status, age, and the depth of MI were independent prognostic variables for 5-year DFS, and age was the only independent prognostic variable for 5-year OS. LVSI and age were independent prognostic variables for locoregional recurrence, while PR status and depth of MI were independent prognostic variables for distant recurrence.
Age, depth of MI, PR status and presence of LVSI are of independent prognostic value for intermediate risk endometrial cancer. The presence of these variables warrants consideration when deciding upon treatment strategies.
确定妇科肿瘤学组 99 （GOG99）标准定义的手术分期中危子宫内膜癌的独立预后因素。
对 239 例FIGO 分期 IB-隐匿性 IIB 子宫内膜样型子宫内膜癌患者进行回顾性研究，这些患者主要接受全面分期手术治疗。收集了临床病理变量、初始手术范围、术后辅助治疗和复发模式的数据。Kaplan-Meier 生存曲线用于估计无病生存（DFS）和总生存（OS），并使用多变量 Cox 回归模型识别独立的预后因素。中位随访时间为 67 个月（范围 12-183 个月）。
5 年 DFS 和 OS 分别为 91.0%和 93.0%。单因素 Kaplan-Meier 分析显示，年龄>60 岁、深肌层浸润（MI）、淋巴血管间隙浸润（LVSI）存在和孕激素受体（PR）阴性与 5 年 DFS 和 OS 降低显著相关。对失败模式的单因素分析表明，年龄较大或 LVSI 阳性的患者更倾向于发生局部区域复发，而 PR 状态和 MI 深度对远处失败有统计学意义。多因素分析显示，PR 状态、年龄和 MI 深度是 5 年 DFS 的独立预后因素，而年龄是 5 年 OS 的唯一独立预后因素。LVSI 和年龄是局部区域复发的独立预后因素，而 PR 状态和 MI 深度是远处复发的独立预后因素。
年龄、MI 深度、PR 状态和 LVSI 的存在对中危子宫内膜癌具有独立的预后价值。这些变量的存在需要在决定治疗策略时加以考虑。
