Bogani Giorgio, Cromi Antonella, Serati Maurizio, Di Naro Edoardo, Donadello Nicoletta, Casarin Jvan, Nardelli Federica, Ghezzi Fabio
*Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese; and †Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
Int J Gynecol Cancer. 2015 Feb;25(2):263-8. doi: 10.1097/IGC.0000000000000337.
The objective of this study was to evaluate how the administration of different adjuvant therapies influences the risk for developing recurrences in the para-aortic area in endometrial cancer (EC) with positive pelvic and unknown para-aortic nodes.
We retrospectively evaluated the data of 58 patients with EC affected by stage IIIC1 who had undergone pelvic but not para-aortic lymphadenectomy from January 1, 1990 to December 31, 2011. Survival outcomes within the first 5 years after surgery were assessed using the Kaplan-Meier model.
Chemotherapy plus radiotherapy, chemotherapy only, and external radiotherapy only were administered in 12 (23%), 18 (34%), and 23 (43%) patients, respectively. Five (9%) patients, who were selected to forego adjuvant therapy due to poor performance status, were excluded from the analysis. Disease-free and overall survivals assessed at 5 years were 54%, and 61%, respectively. All para-aortic recurrences were observed among the patients with endometrioid EC, whereas no cases of para-aortic recurrences were found in patients with nonendometrioid histology (5/36 (14%) vs 0/17 (0%); P = 0.16); the latter were more likely to develop distant (hematogenous, peritoneal, and distant lymphatic) recurrences (P = 0.09). Type of adjuvant therapy was the only factor influencing para-aortic failure: chemotherapy (± radiotherapy) reduced the rate of para-aortic node recurrence in comparison with pelvic radiotherapy as a sole modality (P = 0.01). However, adjuvant therapy did not influence the 5-year survival outcomes (P > 0.05).
In the absence of local treatment (ie, para-aortic lymphadenectomy and radiotherapy), the administration of chemotherapy seems effective in reducing recurrences in the para-aortic area among patients with stage IIIC1 endometrioid EC.
本研究的目的是评估不同辅助治疗方法对盆腔淋巴结阳性且腹主动脉旁淋巴结情况未知的子宫内膜癌（EC）患者腹主动脉旁区域复发风险的影响。
我们回顾性评估了1990年1月1日至2011年12月31日期间接受盆腔淋巴结清扫但未行腹主动脉旁淋巴结清扫的58例IIIC1期EC患者的数据。使用Kaplan-Meier模型评估术后前5年的生存结果。
分别有12例（23%）、18例（34%）和23例（43%）患者接受了化疗加放疗、单纯化疗和单纯外放疗。5例（9%）因身体状况不佳而未接受辅助治疗的患者被排除在分析之外。5年时评估的无病生存率和总生存率分别为54%和61%。所有腹主动脉旁复发均见于子宫内膜样EC患者，而非子宫内膜样组织学患者未发现腹主动脉旁复发病例（5/36（14%）对0/17（0%）；P = 0.16）；后者更易发生远处（血行、腹膜和远处淋巴）复发（P = 0.09）。辅助治疗类型是影响腹主动脉旁失败的唯一因素：与单纯盆腔放疗相比，化疗（±放疗）降低了腹主动脉旁淋巴结复发率（P = 0.01）。然而，辅助治疗并未影响5年生存结果（P > 0.05）。
在未进行局部治疗（即腹主动脉旁淋巴结清扫和放疗）的情况下，化疗似乎可有效降低IIIC1期子宫内膜样EC患者腹主动脉旁区域的复发率。
