Department of Radiation Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Radiation Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Gynecol Oncol. 2014 Jun;133(3):494-8. doi: 10.1016/j.ygyno.2014.03.554. Epub 2014 Mar 20.
The purpose of this study is to identify risk factors for recurrence in a cohort of stage I endometrial cancer patients treated with vaginal cuff brachytherapy at a single academic institution.
From 1989 to 2011, 424 patients with stage I endometrial cancer underwent total hysterectomy and bilateral salpingo-oophorectomy, with or without lymphadenectomy (LND), followed by high-dose-rate vaginal cuff brachytherapy (VCB) to patients felt to be high or intermediate risk FIGO stage IA and IB disease. Covariates included: 2009 FIGO stage, age, grade, histology, presence of lymphovascular space invasion, LND, and receipt of chemotherapy.
With a median follow-up of 3.7years, the 5 and 10-year disease free survival were 98.4% and 95.9%, respectively. A total of 30 patients developed recurrence, with the predominant pattern of isolated distant recurrence (57.0%). On multivariate analysis, grade 3 (p=0.039) and LND (p=0.048) independently predicted of increased recurrence risk. χ(2) analysis suggested that higher-risk patients were selected for LND, with significant differences in age, stage, and grade noted between cohorts. Distant metastatic rate was significantly higher for patients who qualified for GOG 0249 at 23.1% (95% CI 10.7-35.5%) compared to those who did not at 6.8% (95% CI 1.8-11.8%, p<0.001).
Overall disease-free survival for this cohort of patients was >95% at 10years. Univariate analysis confirmed previously identified risk factors as predictors for recurrence. Multivariate analysis found that grade 3 and LND correlated with risk for recurrence. Of those that did recur, the initial site of relapse included distant metastasis in most cases.
本研究旨在确定在单家学术机构接受阴道袖口近距离放疗治疗的 I 期子宫内膜癌患者队列中复发的危险因素。
1989 年至 2011 年，424 例 I 期子宫内膜癌患者接受了全子宫切除术和双侧输卵管卵巢切除术，部分患者还接受了淋巴结切除术（LND），随后对高风险或中风险国际妇产科联合会（FIGO）IA 和 IB 期疾病患者进行了高剂量率阴道袖口近距离放疗（VCB）。协变量包括：2009 年 FIGO 分期、年龄、分级、组织学、淋巴血管空间侵犯、LND 以及是否接受化疗。
中位随访 3.7 年后，5 年和 10 年无病生存率分别为 98.4%和 95.9%。共有 30 例患者出现复发，孤立性远处复发的主要模式占 57.0%。多变量分析显示，分级 3（p=0.039）和 LND（p=0.048）独立预测复发风险增加。卡方检验提示高危患者被选择进行 LND，两个队列在年龄、分期和分级方面存在显著差异。符合 GOG 0249 标准的患者远处转移率为 23.1%（95%CI 10.7-35.5%），明显高于不符合标准的患者（6.8%，95%CI 1.8-11.8%，p<0.001）。
该队列患者的 10 年无病生存率>95%。单因素分析证实了先前确定的危险因素是复发的预测因素。多变量分析发现，分级 3 和 LND 与复发风险相关。在复发的患者中，最初的复发部位包括大多数情况下的远处转移。
