Turan Taner, Ureyen Isin, Duzguner Ipek, Ozkaya Enis, Tasci Tolga, Karalok Alper, Boran Nurettin, Kose M Faruk, Tulunay Gokhan
*Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara; †Department of Obstetrics and Gynecology, Dr. Sami Ulus Maternity and Women's Health Training and Research Hospital, Ankara; and ‡Department of Obstetrics and Gynecology, Bahcesehir University School of Medicine, Istanbul, Turkey.
Int J Gynecol Cancer. 2014 Jul;24(6):1033-41. doi: 10.1097/IGC.0000000000000154.
We aimed to define the factors that are related to recurrence and survival in patients with stage IIIC endometrial carcinoma in this study.
A total of 147 patients who underwent staging surgery and had a diagnosis of stage IIIC1 to IIIC2 endometrial cancer according to the International Federation of Gynecology and Obstetrics 2009 were included. Patients whose data could not be obtained and patients with a diagnosis of uterine sarcoma and with synchronous tumors were excluded.
Mean age of the patients was 58.6 years. Among these patients, 63 had stage IIIC1 and 84 had stage IIIC2 disease. Extrauterine spread was detected in 22% of the patients. Median number of paraaortic (PA) and pelvic lymph nodes removed were 16.5 and 38, respectively. Paraaortic and pelvic nodal involvements were detected in 84 patients and 125 patients, respectively. Radiotherapy was applied more commonly as an adjuvant therapy. Three-year progression-free survival (PFS) and 3-year disease-specific survival (DSS) were 65% and 84%, respectively. Seventy percent of the recurrences were outside the pelvis. Site of metastatic lymph nodes and the number of metastatic PA lymph nodes were associated with 3-year PFS and lymphovascular space invasion; site of metastatic lymph nodes and the presence of recurrence were associated with 3-year DSS in the univariate analysis. Although any surgicopathological factor was not related to 3-year PFS, only the presence of recurrence was an independent prognostic factor for a 3-year DSS in the multivariate analysis (hazard ratio, 0.017; 95% confidence interval, 0.002-0.183).
The number of debulked metastatic lymph nodes and PA involvement were associated with recurrence in the univariate analysis. The presence of recurrence was the only independent prognostic factor detecting survival. Therefore, systematic lymphadenectomy involving PA lymph nodes instead of sampling should be performed in patients with high risk for nodal involvement in endometrial cancer.
在本研究中，我们旨在确定与IIIC期子宫内膜癌患者复发和生存相关的因素。
纳入了147例行分期手术且根据2009年国际妇产科联盟诊断为IIIC1至IIIC2期子宫内膜癌的患者。排除数据无法获取的患者以及诊断为子宫肉瘤和同时患有其他肿瘤的患者。
患者的平均年龄为58.6岁。在这些患者中，63例为IIIC1期，84例为IIIC2期。22%的患者检测到子宫外扩散。切除的腹主动脉旁（PA）和盆腔淋巴结的中位数分别为16.5个和38个。分别在84例和125例患者中检测到腹主动脉旁和盆腔淋巴结转移。放疗作为辅助治疗应用更为普遍。三年无进展生存期（PFS）和三年疾病特异性生存期（DSS）分别为65%和84%。70%的复发发生在盆腔外。在单因素分析中，转移性淋巴结部位和转移性PA淋巴结数量与三年PFS及淋巴管间隙浸润相关；转移性淋巴结部位和复发情况与三年DSS相关。尽管任何手术病理因素均与三年PFS无关，但在多因素分析中，仅复发情况是三年DSS的独立预后因素（风险比，0.017；95%置信区间，0.002 - 0.183）。
在单因素分析中，减瘤后转移性淋巴结数量和PA受累与复发相关。复发情况是检测生存的唯一独立预后因素。因此，对于子宫内膜癌淋巴结受累风险高的患者，应进行包括PA淋巴结的系统性淋巴结清扫而非取样。
