Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
Br J Cancer. 2013 Oct 1;109(7):1760-5. doi: 10.1038/bjc.2013.521. Epub 2013 Sep 3.
Radical hysterectomy is recommended for endometrial adenocarcinoma patients with suspected gross cervical involvement. However, the efficacy of operative procedure has not been confirmed.
The patients with endometrial adenocarcinoma who had suspected gross cervical involvement and underwent hysterectomy between 1995 and 2009 at seven institutions were retrospectively analysed (Gynecologic Oncology Trial and Investigation Consortium of North Kanto: GOTIC-005). Primary endpoint was overall survival, and secondary endpoints were progression-free survival and adverse effects.
A total of 300 patients who underwent primary surgery were identified: 74 cases with radical hysterectomy (RH), 112 patients with modified radical hysterectomy (mRH), and 114 cases with simple hysterectomy (SH). Median age was 47 years, and median duration of follow-up was 47 months. There were no significant differences of age, performance status, body mass index, stage distribution, and adjuvant therapy among three groups. Multi-regression analysis revealed that age, grade, peritoneal cytology status, and lymph node involvement were identified as prognostic factors for OS; however, type of hysterectomy was not selected as independent prognostic factor for local recurrence-free survival, PFS, and OS. Additionally, patients treated with RH had longer operative time, higher rates of blood transfusion and severe urinary tract dysfunction.
Type of hysterectomy was not identified as a prognostic factor in endometrial cancer patients with suspected gross cervical involvement. Perioperative and late adverse events were more frequent in patients treated with RH. The present study could not find any survival benefit from RH for endometrial cancer patients with suspected gross cervical involvement. Surgical treatment in these patients should be further evaluated in prospective clinical studies.
对于疑似宫颈广泛受累的子宫内膜腺癌患者，推荐行根治性子宫切除术。然而，手术效果尚未得到证实。
对 1995 年至 2009 年间在七个机构接受手术治疗且疑似宫颈广泛受累的子宫内膜腺癌患者进行回顾性分析（日本北关东妇科肿瘤临床试验协作组：GOTIC-005）。主要终点为总生存，次要终点为无进展生存和不良事件。
共纳入 300 例接受初次手术的患者：74 例行根治性子宫切除术（RH），112 例行改良根治性子宫切除术（mRH），114 例行单纯子宫切除术（SH）。中位年龄为 47 岁，中位随访时间为 47 个月。三组患者在年龄、体力状态、体重指数、分期分布和辅助治疗方面无显著差异。多因素回归分析显示，年龄、分级、腹腔细胞学状态和淋巴结受累是 OS 的预后因素；然而，子宫切除术类型未被选为局部无复发生存、PFS 和 OS 的独立预后因素。此外，RH 组的手术时间更长，输血率和严重泌尿道功能障碍的发生率更高。
在疑似宫颈广泛受累的子宫内膜癌患者中，子宫切除术类型不是预后因素。RH 组患者围手术期和晚期不良事件更常见。本研究未发现 RH 对疑似宫颈广泛受累的子宫内膜癌患者有生存获益。这些患者的手术治疗应在前瞻性临床研究中进一步评估。
