Oakley G, Nahhas W A
Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, Ohio.
Eur J Gynaecol Oncol. 1989;10(4):255-60.
Adenocarcinoma of the endometrium is diagnosed by the histologic evaluation of endometrial tissue. In stage I disease, five-year survival depends upon a number of prognostic factors. Histologic grade and type of carcinoma are most important. The need for pelvic and para-aortic lymphadenectomy is often based on the preoperative histologic grade and type of tumor. The purpose of this study was: 1) to compare preoperative histology of endometrial carcinoma to that found at hysterectomy, 2) to determine if preoperative histology can accurately predict depth of myometrial invasion or extra-uterine spread, 3) to determine whether para-aortic lymphadenectomy could be deleted based only on the preoperative finding of well differentiated carcinoma. In 19 (28%) of the 68 patients studied, the histologic grade or pattern at hysterectomy was different from that found preoperatively. In seven (13%) of the 52 "good prognosis" patients with grades 1 and 2 preoperative histology, hysterectomy revealed a more serious histologic type. Three of the seven (43%) had extrauterine spread. In the 16 "poor prognosis" patients with preoperative grade 3 or papillary serous/clear cell carcinoma, 14 (88%) had a similar histologic pattern at hysterectomy. Three of these patients had metastatic disease. Depth of myometrial invasion could not be predicted by preoperative histology even though the data suggested that extrauterine spread could. Clinical stage I endometrial carcinoma, grade 1 or 2, should not be treated without para-aortic nodal sampling based only on a supposedly favorable preoperative histologic pattern. Confirmed para-aortic nodal disease will alter the fields of post-operative radiation therapy should that become necessary. In these patients, however, pelvic lymphadenectomy is not justified.2 +
子宫内膜腺癌通过对子宫内膜组织进行组织学评估来诊断。在Ⅰ期疾病中，五年生存率取决于许多预后因素。组织学分级和癌的类型最为重要。盆腔和腹主动脉旁淋巴结切除术的必要性通常基于术前肿瘤的组织学分级和类型。本研究的目的是：1）比较子宫内膜癌的术前组织学与子宫切除术中发现的组织学；2）确定术前组织学是否能准确预测肌层浸润深度或子宫外扩散；3）确定是否仅根据术前高分化癌的发现就可省略腹主动脉旁淋巴结切除术。在研究的68例患者中，19例（28%）子宫切除术中的组织学分级或模式与术前发现的不同。在52例术前组织学分级为1级和2级的“预后良好”患者中，7例（13%）子宫切除术显示组织学类型更严重。这7例中的3例（43%）有子宫外扩散。在16例术前分级为3级或乳头状浆液性/透明细胞癌的“预后不良”患者中，14例（88%）在子宫切除术中具有相似的组织学模式。这些患者中有3例有转移性疾病。尽管数据表明术前组织学可预测子宫外扩散，但无法预测肌层浸润深度。临床Ⅰ期子宫内膜癌，1级或2级，不应仅基于假定良好的术前组织学模式而不进行腹主动脉旁淋巴结取样就进行治疗。如果有必要，确诊的腹主动脉旁淋巴结疾病将改变术后放疗的范围。然而，在这些患者中，盆腔淋巴结切除术是不合理的。
