改善欧洲肿瘤内科学会（ESMO）早期子宫内膜癌风险分组的线索？淋巴管血管侵犯的影响。
A clue towards improving the European Society of Medical Oncology risk group classification in apparent early stage endometrial cancer? Impact of lymphovascular space invasion.
机构信息
1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France [2] INSERM UMR S 707, 'Epidemiology, Information Systems, Modeling', University Pierre and Marie Curie, Paris, France.
Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France.
出版信息
Br J Cancer. 2014 May 27;110(11):2640-6. doi: 10.1038/bjc.2014.237. Epub 2014 May 8.
BACKGROUND
Lymphovascular space invasion (LVSI) is one of the most important predictors of nodal involvement and recurrence in early stage endometrial cancer (EC). Despite its demonstrated prognostic value, LVSI has not been incorporated into the European Society of Medical Oncology (ESMO) classification. The aim of this prospective multicentre database study is to investigate whether it may improve the accuracy of the ESMO classification in predicting the recurrence risk.
METHODS
Data of 496 patients with apparent early-stage EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from prospective multicentre database. A modified ESMO classification including six risk groups was created after inclusion of the LVSI status in the ESMO classification. The primary end point was the recurrence accuracy comparison between the ESMO and the modified ESMO classifications with respect to the area under the receiver operating characteristic curve (AUC).
RESULTS
The recurrence rate in the whole population was 16.1%. The median follow-up and recurrence time were 31 (range: 1-152) and 27 (range: 1-134) months, respectively. Considering the ESMO modified classification, the recurrence rates were 8.2% (8 out of 98), 23.1% (15 out of 65), 25.9% (15 out of 58), and 45.1% (28 out of 62) for intermediate risk/LVSI-, intermediate risk/LVSI+, high risk/LVSI-, and high risk/LVSI+, respectively (P<0.001). In the low risk group, LVSI status was not discriminant as only 7.0% (14 out of 213) had LVSI+. The staging accuracy according to AUC criteria for ESMO and ESMO modified classifications were of 0.71 (95% CI: 0.68-0.74) and 0.74 (95% CI: 0.71-0.77), respectively.
CONCLUSIONS
The current modified classification could be helpful to better define indications for nodal staging and adjuvant therapy, especially for patients with intermediate risk EC.
背景
淋巴血管空间侵犯（LVSI）是早期子宫内膜癌（EC）淋巴结转移和复发的最重要预测因子之一。尽管已经证明其具有预后价值，但 LVSI 尚未纳入欧洲肿瘤内科学会（ESMO）分类。本前瞻性多中心数据库研究的目的是探讨其是否可以提高 ESMO 分类预测复发风险的准确性。
方法
从 2001 年 1 月至 2012 年 12 月接受初次手术治疗的 496 例早期 EC 患者的前瞻性多中心数据库中提取数据。在 ESMO 分类中纳入 LVSI 状态后，创建了包含六个风险组的改良 ESMO 分类。主要终点是修改后的 ESMO 分类和 ESMO 分类的接受者操作特征曲线（ROC）下面积（AUC）之间的复发准确性比较。
结果
全人群的复发率为 16.1%。中位随访和复发时间分别为 31（范围：1-152）和 27（范围：1-134）个月。考虑改良 ESMO 分类，中危/LVSI-、中危/LVSI+、高危/LVSI-和高危/LVSI+的复发率分别为 8.2%（8/98）、23.1%（15/65）、25.9%（15/58）和 45.1%（28/62）（P<0.001）。在低危组中，LVSI 状态无明显差异，仅 7.0%（14/213）有 LVSI+。根据 AUC 标准，ESMO 和 ESMO 改良分类的分期准确性分别为 0.71（95%CI：0.68-0.74）和 0.74（95%CI：0.71-0.77）。
结论
目前的改良分类有助于更好地确定淋巴结分期和辅助治疗的指征，特别是对于中危 EC 患者。
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