Takahashi Akimasa, Matsuura Motoki, Matoda Maki, Nomura Hidetaka, Okamoto Sanshiro, Kanao Hiroyuki, Kondo Eiji, Omatsu Kohei, Kato Kazuyoshi, Utsugi Kuniko, Takeshima Nobuhiro
Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
Int J Gynecol Cancer. 2017 Jun;27(5):967-972. doi: 10.1097/IGC.0000000000000984.
The incidence of endometrial carcinoma has been increasing annually in developed nations; it is currently the second most common gynecological malignancy. Although the majority of patients are diagnosed at an early stage, 15% to 20% reportedly recur; consequently, patients are usually followed clinically for 3 years after the initial curative surgery. We therefore aimed to determine the incidence and clinicopathological features of early and late recurrences of endometrial carcinoma after surgical resection.
This retrospective study was performed using the clinical records of 2233 patients who underwent surgical resection for endometrial carcinoma between January 1970 and December 2009 at a single cancer center. Tumor recurrences were classified as early (<5 years) and late (>5 years) after initial surgery. Clinicopathological variables and tumor recurrence patterns were compared between the early and late recurrence groups. Survival analysis was performed using the Kaplan-Meier method.
Among 2233 study patients, 255 (11.4%) experienced endometrial carcinoma recurrence; of these, early and late recurrences occurred in 232 (91.0%) and 23 (9.0%) patients, respectively. Late recurrence was associated with invasion of less than half of the myometrium at diagnosis and the presence of histopathological features of endometrioid adenocarcinoma with low- or intermediate-grade histological subtype and absence of lymphovascular invasion. After recurrence, there was no significant difference in overall survival between the early and late recurrence groups (P = 0.437). Furthermore, surgical treatment was associated with a significantly improved prognosis in the late recurrence group (P = 0.044).
The findings of this study indicated that patients who initially underwent successful treatment for low-grade and early-stage endometrial carcinoma should be followed clinically for more than 5 years. In cases of late recurrence, surgical management may improve prognosis.
在发达国家，子宫内膜癌的发病率逐年上升；它目前是第二常见的妇科恶性肿瘤。尽管大多数患者在早期被诊断出来，但据报道仍有15%至20%会复发；因此，患者通常在初次根治性手术后接受3年的临床随访。我们旨在确定手术切除后子宫内膜癌早期和晚期复发的发生率及临床病理特征。
本回顾性研究使用了1970年1月至2009年12月期间在单一癌症中心接受子宫内膜癌手术切除的2233例患者的临床记录。肿瘤复发被分为初次手术后的早期（<5年）和晚期（>5年）。比较早期和晚期复发组的临床病理变量及肿瘤复发模式。采用Kaplan-Meier法进行生存分析。
在2233例研究患者中，255例（11.4%）发生了子宫内膜癌复发；其中，早期和晚期复发分别发生在232例（91.0%）和23例（9.0%）患者中。晚期复发与诊断时肌层浸润少于一半、存在低级别或中级别组织学亚型的子宫内膜样腺癌的组织病理学特征且无淋巴管浸润有关。复发后，早期和晚期复发组的总生存率无显著差异（P = 0.437）。此外，手术治疗与晚期复发组的预后显著改善相关（P = 0.044）。
本研究结果表明，最初成功治疗低级别和早期子宫内膜癌的患者应接受超过5年的临床随访。在晚期复发的情况下，手术治疗可能改善预后。
