Matsuo Koji, Opper Neisha R, Ciccone Marcia A, Garcia Jocelyn, Tierney Katherine E, Baba Tsukasa, Muderspach Laila I, Roman Lynda D
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; and the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Obstet Gynecol. 2015 Feb;125(2):424-433. doi: 10.1097/AOG.0000000000000636.
To examine whether wait time between endometrial biopsy and surgical staging correlates with tumor characteristics and affects survival outcomes in patients with type I endometrial cancer.
A retrospective study was conducted to examine patients with grade 1 and 2 endometrioid adenocarcinoma diagnosed by preoperative endometrial biopsy who subsequently underwent hysterectomy-based surgical staging between 2000 and 2013. Patients who received neoadjuvant chemotherapy or hormonal treatment were excluded. Time interval and grade change between endometrial biopsy and hysterectomy were correlated to demographics and survival outcomes.
Median wait time was 57 days (range 1-177 days) among 435 patients. Upgrading of the tumor to grade 3 in the hysterectomy specimen was seen in 4.7% of 321 tumors classified as grade 1 and 18.4% of 114 tumors classified as grade 2 on the endometrial biopsy, respectively. Wait time was not associated with grade change (P>.05). Controlling for age, ethnicity, body habitus, medical comorbidities, CA 125 level, and stage, multivariable analysis revealed that wait time was not associated with survival outcomes (5-year overall survival rates, wait time 1-14, 15-42, 43-84, and 85 days or more; 62.5%, 93.6%, 95.2%, and 100%, respectively, P>.05); however, grade 1 to 3 on the hysterectomy specimen remained as an independent prognosticator associated with decreased survival (5-year overall survival rates, grade 1 to 3 compared with grade change 1 to 1, 82.1% compared with 98.5%, P=.01). Among grade 1 preoperative biopsies, grade 1 to 3 was significantly associated with nonobesity (P=.039) and advanced stage (P=.019).
Wait time for surgical staging was not associated with decreased survival outcome in patients with type I endometrial cancer.
探讨I型子宫内膜癌患者子宫内膜活检与手术分期之间的等待时间是否与肿瘤特征相关，并影响生存结局。
进行一项回顾性研究，以检查2000年至2013年间经术前子宫内膜活检诊断为1级和2级子宫内膜样腺癌且随后接受了基于子宫切除术的手术分期的患者。排除接受新辅助化疗或激素治疗的患者。子宫内膜活检与子宫切除术之间的时间间隔和分级变化与人口统计学和生存结局相关。
435例患者的中位等待时间为57天（范围1 - 177天）。在子宫内膜活检中分类为1级的321个肿瘤中，4.7%在子宫切除标本中肿瘤升级为3级；在分类为2级的114个肿瘤中，18.4%在子宫切除标本中肿瘤升级为3级。等待时间与分级变化无关（P>0.05）。在控制年龄、种族、身体状况、合并症、CA 125水平和分期后，多变量分析显示等待时间与生存结局无关（5年总生存率，等待时间1 - 14天、15 - 42天、43 - 84天和84天以上分别为62.5%、93.6%、95.2%和100%，P>0.05）；然而，子宫切除标本中1级至3级仍然是与生存率降低相关的独立预后因素（5年总生存率，1级至3级与分级不变1级至1级相比，分别为82.1%与98.5%，P = 0.01）。在术前活检为1级的患者中，1级至3级与非肥胖（P = 0.039）和晚期（P = 0.019）显著相关。
I型子宫内膜癌患者手术分期的等待时间与生存结局降低无关。
