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[参照临床和形态学预后因素对718例子宫内膜癌的治疗结果]

[Results of treatment of 718 endometrial cancers with reference to clinical and morphologic prognostic factors].

作者信息

Köhler U, Forberg J

机构信息

Klinik für Gynäkologie und Geburtshilfe, Bereichs Medizin der Karl-Marx-Universität, Leipzig.

出版信息

Zentralbl Gynakol. 1989;111(15):1033-41.

PMID:2816152
Abstract

This article deals with a retrospective analysis of therapeutic achievements in 718 endometrial carcinoma patients in relation to important prognostic factors (clinical stage, age, tumour type/degree of differentiation). The unfavourable age structure (64.9 years) and frequent multimorbidity of endometrial cancer patients require a close interdisciplinary cooperation for optimal management planning. With the priority of a graduated operative procedure with differential additional radiation therapy on the basis of essential clinical and morphological factors in contrast to the primary radiation therapy, the unsettled cumulative 5-year-survival rate accounted for in stage Ia 69%, Ib 64%, II 41%, III 33% and also for the whole material 59%. The obvious deterioration of the prognosis already with the involvement of the cervix (stage II) as well as in the presence of unfavourable prognostic factors in stage I (tumour type, undifferentiated, myometrial invasion, suspicion of lymph node involvement) justify a radical operative intervention (lymphadenectomy, Wertheim-Meigs) in these cases despite possible anaesthesiological risk on the basis of an extended pretherapeutic diagnostic procedures (sonography, lymphography, computer tomography). Under these conditions mentioned above we had only 6 per cent late therapeutic consequences requiring treatment.

摘要

本文对718例子宫内膜癌患者的治疗成果进行回顾性分析,分析内容涉及重要的预后因素(临床分期、年龄、肿瘤类型/分化程度)。子宫内膜癌患者的年龄结构不理想(平均年龄64.9岁)且常伴有多种疾病,这就需要紧密的多学科合作来制定最佳治疗方案。与单纯的放疗不同,在关键的临床和形态学因素基础上,优先采用分级手术并辅以不同的放射治疗,Ia期患者5年累积生存率为69%,Ib期为64%,II期为41%,III期为33%,总体生存率为59%。即便在Ia期,只要出现预后不良因素(肿瘤类型、未分化、肌层浸润、怀疑有淋巴结转移),或者累及宫颈(II期),患者的预后就会明显变差,这就说明在这些情况下,尽管可能存在麻醉风险,但基于广泛的治疗前诊断程序(超声、淋巴造影、计算机断层扫描),仍有必要进行根治性手术干预(淋巴结清扫术、Wertheim-Meigs手术)。在上述条件下,我们只有6%的患者出现需要治疗的晚期治疗结果。

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