Hanley Krisztina Z, Fadare Oluwole, Fisher Kevin E, Atkins Kristen A, Mosunjac Marina B
Department of Pathology and Laboratory Medicine (K.Z.H., K.E.F., M.B.M.), Emory University Hospital, Atlanta, GeorgiaDepartment of Pathology (O.F.), University of California San Diego, San Diego, CaliforniaDepartment of Pathology and Laboratory Medicine (K.A.A.), University of Virginia, Charlottesville, Virginia.
Int J Gynecol Pathol. 2016 May;35(3):249-55. doi: 10.1097/PGP.0000000000000235.
Uterine papillary serous carcinoma (UPSC) represents 10% of endometrial carcinomas. Significant number of patients initially present with extrauterine disease. The role of adjuvant treatment in low stage, especially polyp-confined UPSC is controversial. This multi-institutional study evaluated the significance of positive pelvic washing (PW) and adjuvant treatment on disease recurrence in a setting of endometrial polyp-confined UPSC. Surgical pathology files from 3 institutions were searched for cases of endometrial polyp-confined UPSC. Following histologic review, cases were clinically staged as Stage I, without myoinvasion or lymphovascular invasion. Clinicopathologic characteristics, results of PW, and type of adjuvant therapy were recorded. Statistical analysis using the Kaplan-Meier method for survival and Fisher exact test were performed. Thirty-three patients were included in the study. All patients were diagnosed with polyp-confined UPSC. The size of the polyp ranged from 0.3 to 4.3 cm. PW was positive for tumor cells in 8/33 (24%) patients. Twenty-two patients (66.6%) received some type of adjuvant treatment. Six patients (18%) developed recurrent disease. There was no significant difference in disease-free survival in the patients receiving adjuvant treatment versus not (P=0.375). However, there was significant association (P=0.0013) between positive PW and disease recurrence. Data are conflicting whether positive PW affects prognosis in low-stage endometrial carcinomas. Our study showed that in UPSC, malignant cells can be present in PW without lymphovascular invasion or myoinvasion and may have negative prognostic implication. Our data also reflect the controversies in the role of adjuvant treatment in endometrium-confined UPSC.
子宫浆液性乳头状癌（UPSC）占子宫内膜癌的10%。相当数量的患者初诊时即伴有子宫外疾病。辅助治疗在低分期，尤其是局限于息肉的UPSC中的作用存在争议。这项多机构研究评估了在局限于子宫内膜息肉的UPSC中，盆腔冲洗液阳性（PW）及辅助治疗对疾病复发的意义。检索了3家机构的手术病理档案，以查找局限于子宫内膜息肉的UPSC病例。经过组织学复查后，将病例临床分期为Ⅰ期，无肌层浸润或脉管浸润。记录临床病理特征、PW结果及辅助治疗类型。采用Kaplan-Meier生存分析法和Fisher精确检验进行统计学分析。33例患者纳入研究。所有患者均诊断为局限于息肉的UPSC。息肉大小为0.3至4.3厘米。33例患者中有8例（24%）PW中肿瘤细胞呈阳性。22例患者（66.6%）接受了某种类型的辅助治疗。6例患者（18%）出现疾病复发。接受辅助治疗与未接受辅助治疗的患者无病生存期无显著差异（P=0.375）。然而，PW阳性与疾病复发之间存在显著关联（P=0.0013）。关于PW阳性是否影响低分期子宫内膜癌的预后，数据存在矛盾。我们的研究表明，在UPSC中，PW中可存在恶性细胞，而无脉管浸润或肌层浸润，且可能具有不良预后意义。我们的数据也反映了辅助治疗在局限于子宫内膜的UPSC中的作用存在争议。
