Turan Taner, Ureyen Işın, Karalök Alper, Taşçı Tolga, Ilgın Hilal, Keskin Levent, Kose M Faruk, Tulunay Gökhan
Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital, Ankara, Turkey.
Department of Gynecology and Obstetrics, Ankara Atatürk Education and Research Hospital, Ankara, Turkey.
J Turk Ger Gynecol Assoc. 2014 Aug 8;15(3):164-72. doi: 10.5152/jtgga.2014.13109. eCollection 2014.
To identify surgico-pathologic factors, survival, and the factors determining survival in patients with omental metastasis from endometrial cancer.
Patients with endometrial cancer operated on between 1993-2012 in our hospital and who had omental metastases were included. Patients with either uterine sarcoma or synchronous tumors were excluded.
Omentectomy was performed in 811 patients with endometrial cancer, and omental metastasis was found in 48 (5.9%) patients. Tumor type was endometrioid cancer in 26 patients. Omental metastasis was macroscopic and microscopic in 60% and 40% of the patients, respectively. Total omentectomy increased the chance of detection of the microscopic metastases. Among the patients with omental metastasis, 68.8% had positive peritoneal cytology, 66.7% had adnexal involvement, 60.5% had metastases in the lymph nodes, 47.9% had cervical involvement, and 29.2% had serosal involvement; 43.8% of these patients had intra-abdominal spread beyond the omentum, adnexa, and peritoneal cytology. Two-year disease-free survival (DFS) was 28.2%, and 2-y overall survival (OS) was 40%. The depth of myometrial invasion, grade, cytology, and status of pelvic lymph nodes affected 2-y DFS, while cervical invasion and cytology affected 2-y OS.
Omental metastasis in endometrial cancer means poor prognosis, and two-thirds of these patients are lost at the end of the second year. Although total omentectomy increases the chance of the detection of micrometastases, its effect on survival is controversial. New treatment modalities are necessary in this patient group.
确定子宫内膜癌伴网膜转移患者的外科病理因素、生存率及影响生存的因素。
纳入1993年至2012年在我院接受手术且发生网膜转移的子宫内膜癌患者。排除子宫肉瘤或同步肿瘤患者。
811例行子宫内膜癌手术的患者中，48例（5.9%）发现有网膜转移。26例患者的肿瘤类型为子宫内膜样癌。网膜转移在60%的患者中为肉眼可见，40%的患者为显微镜下可见。全网膜切除术增加了显微镜下转移灶的检出几率。在网膜转移患者中，68.8%的患者腹膜细胞学检查呈阳性，66.7%的患者附件受累，60.5%的患者有淋巴结转移，47.9%的患者宫颈受累，29.2%的患者浆膜受累；这些患者中有43.8%存在腹腔内扩散，超出网膜、附件和腹膜细胞学检查范围。两年无病生存率（DFS）为28.2%，两年总生存率（OS）为40%。肌层浸润深度、分级、细胞学检查及盆腔淋巴结状态影响两年DFS，而宫颈浸润和细胞学检查影响两年OS。
子宫内膜癌的网膜转移意味着预后不良，这些患者中有三分之二在第二年年底死亡。尽管全网膜切除术增加了微转移灶的检出几率，但其对生存的影响存在争议。该患者群体需要新的治疗方式。
