*Department of Radiation Oncology, †Department of Pathology, ‡Public Health Science, and §Division of Gynecologic Oncology, Department of Women's Health Services, Henry Ford Hospital, Detroit, MI.
Int J Gynecol Cancer. 2014 Jan;24(1):97-101. doi: 10.1097/IGC.0000000000000018.
This study aimed to determine the impact of tumor grade on patterns of recurrence and survival end points in patients with endometrioid carcinoma 2009 International Federation of Gynecology and Obstetrics stages I-II.
We identified 949 patients who underwent hysterectomy between 1988 and 2011. Patients were divided into 3 groups based on tumor grade. Kaplan-Meier plots were generated for each group for recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS).
Median follow-up was 52 months. Median age was 60 years. All patients underwent total abdominal hysterectomy and salpingo-oophorectomy. Eighty percent of patients underwent lymph node dissection, 83% had peritoneal cytology. There were 76 (8%) patients who developed tumor recurrence. Tumor recurrence rates were significantly higher in patients with grade 3 tumors compared to grade 1 (P = 0.006). Additionally, patients with grade 3 tumors developed significantly more frequent distant metastases compared to patients with grade 1 (P = 0.002). Five-year RFS for the patients with grade 1, 2, and 3 were 95%, 82%, and 68%, respectively (P = <0.001). Five-year DSS was 99%, 93%, and 79%, respectively (P = <0.001). Five-year OS was 89%, 84%, and 63%, respectively (P = <0.001). Lymphovascular space involvement and grade were significant independent predictors of RFS and DSS. For OS age, lymphovascular space involvement, grade, and body mass index were significant predictors.
International Federation of Gynecology and Obstetrics grade is a strong predictor of clinical survival end points in women with early-stage endometrioid carcinoma. The pattern of recurrence in patients with grade 3 tumors is mainly distant rather than locoregional. Further studies incorporating systemic therapy in the adjuvant settings in these patients are warranted.
本研究旨在确定肿瘤分级对 2009 年国际妇产科联合会（FIGO）分期 I-II 期子宫内膜样癌患者复发模式和生存终点的影响。
我们确定了 949 例 1988 年至 2011 年间接受子宫切除术的患者。根据肿瘤分级将患者分为 3 组。为每组生成无复发生存（RFS）、疾病特异性生存（DSS）和总生存（OS）的 Kaplan-Meier 图。
中位随访时间为 52 个月。中位年龄为 60 岁。所有患者均行全子宫切除术和双侧附件切除术。80%的患者行淋巴结清扫术，83%行腹膜细胞学检查。有 76 例（8%）患者发生肿瘤复发。与 1 级肿瘤患者相比，3 级肿瘤患者的肿瘤复发率明显更高（P = 0.006）。此外，与 1 级肿瘤患者相比，3 级肿瘤患者发生远处转移的频率明显更高（P = 0.002）。1 级、2 级和 3 级患者的 5 年 RFS 分别为 95%、82%和 68%（P <0.001）。5 年 DSS 分别为 99%、93%和 79%（P <0.001）。5 年 OS 分别为 89%、84%和 63%（P <0.001）。脉管侵犯和分级是 RFS 和 DSS 的独立显著预测因素。对于 OS，年龄、脉管侵犯、分级和体重指数是显著的预测因素。
FIGO 分级是早期子宫内膜样癌患者临床生存终点的有力预测因素。3 级肿瘤患者的复发模式主要是远处转移，而不是局部复发。在这些患者的辅助治疗中进一步研究全身性治疗是有必要的。
