Lum Marija M, Belnap Thomas W, Frandsen Jonathan, Brown Aaron P, Sause William T, Soisson Andrew P, Dodson Mark K, Werner Theresa, Gaffney David K
*Radiation Oncology ‡Gynecological Oncology, Intermountain Medical Center, Murray §Radiation Oncology †Gynecological Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, UT.
Am J Clin Oncol. 2015 Jun;38(3):283-8. doi: 10.1097/COC.0b013e31829c12be.
Endometrial cancer patients with positive serosa and/or adnexae (FIGO stage IIIA) have a variable prognosis and are at a significant risk for recurrence. We investigated how tumor characteristics and adjuvant treatments influence the overall survival (OS) and recurrence patterns in these patients and patients with positive cytology alone (previously classified as stage IIIA before 2009).
This multi-institution retrospective study reviewed 55 patients with positive serosa and/or adnexae and 18 patients with positive cytology only, surgically staged from 1990 to 2010. The study cohort was evaluated using the Kaplan-Meier estimates of OS and Cox proportional hazards modeling.
The 5-year OS for all IIIA patients was 55%. Administration of adjuvant therapy was associated with improved OS when compared with surgery alone (P=0.0018). The 5-year OS was 20% for patients treated with surgery alone (n=10), 55% with surgery and radiation therapy (n=26), 75% with surgery and chemotherapy (n=7), and 79% with surgery followed by both radiation therapy and chemotherapy (n=12; P=0.005). The tumor characteristics showed that nonendometrioid histology (P=0.0143) and lymph vascular space invasion (P=0.0483) had a poorer OS. Recurrence occurred in 29% of IIIA patients, with 9% locoregional failures and 20% distant failures. Patients with positive cytology only had a similar OS to patients with positive serosa and/or adnexae (76% vs. 55%; P=0.104) and recurrence rate (22% vs. 29%; P=0.4101).
This retrospective study suggests benefit from the use of adjuvant radiotherapy and chemotherapy for stage IIIA patients. We recommend further investigation of adjuvant therapies for IIIA patients in prospective studies and randomized clinical trials.
浆膜和/或附件阳性的子宫内膜癌患者（国际妇产科联盟（FIGO）III A期）预后各异，复发风险显著。我们研究了肿瘤特征和辅助治疗如何影响这些患者以及仅细胞学阳性患者（2009年前曾归类为III A期）的总生存期（OS）和复发模式。
这项多机构回顾性研究纳入了1990年至2010年期间接受手术分期的55例浆膜和/或附件阳性患者以及18例仅细胞学阳性患者。使用Kaplan-Meier法估计总生存期并采用Cox比例风险模型对研究队列进行评估。
所有III A期患者的5年总生存率为55%。与单纯手术相比，辅助治疗可改善总生存期（P = 0.0018）。单纯手术治疗的患者（n = 10）5年总生存率为20%，手术联合放疗的患者（n = 26）为55%，手术联合化疗的患者（n = 7）为75%，手术联合放疗及化疗的患者（n = 12）为79%（P = 0.005）。肿瘤特征显示，非子宫内膜样组织学类型（P = 0.0143）和淋巴血管间隙浸润（P = 0.0483）的总生存期较差。29%的III A期患者出现复发，其中9%为局部区域复发，20%为远处复发。仅细胞学阳性患者的总生存期与浆膜和/或附件阳性患者相似（76%对55%；P = 0.104），复发率也相似（22%对29%；P = 0.4101）。
这项回顾性研究表明，III A期患者使用辅助放疗和化疗有益。我们建议在前瞻性研究和随机临床试验中进一步研究III A期患者的辅助治疗。
