Tuomi Taru, Pasanen Annukka, Leminen Arto, Bützow Ralf, Loukovaara Mikko
Departments of *Obstetrics and Gynecology and †Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Int J Gynecol Cancer. 2017 Jun;27(5):923-930. doi: 10.1097/IGC.0000000000000970.
The aim of this study was to investigate the association of predictors of an advanced disease and/or poor outcome with the occurrence of tumor relapses in different anatomical sites in patients with stage I-II endometrioid endometrial cancer.
A total of 929 patients were included in the study. The median follow-up time was 57 months (range, 1-108 months). The studied variables were: poor tumor differentiation, myometrial invasion 50% or greater, tumor size 3 cm or greater, lymphovascular space invasion, cervical stromal invasion, positive peritoneal cytology, old age (>77 years), obesity (body mass index ≥30 kg/m), and diabetes.
A relapse was diagnosed in 98 patients (10.5%) (vaginal in 15, pelvic in 27, intra-abdominal beyond the pelvis in 27, extra-abdominal in 29). None of the variables were associated with an altered risk of vaginal or pelvic relapses in univariate analyses. Poor differentiation, myometrial invasion 50% or greater, tumor size 3 cm or greater, and positive peritoneal cytology were associated with an increased risk of intra-abdominal relapses beyond the pelvis (odds ratios [ORs] between 2.2 and 9.6). With the exception of obesity and diabetes, all variables were associated with an increased risk of extra-abdominal relapses (ORs between 2.3 and 13). Tumor size 3 cm or greater (OR, 3.1) and positive peritoneal cytology (OR, 16) predicted intra-abdominal relapses beyond the pelvis in multivariate analysis, whereas poor differentiation (OR, 2.9), myometrial invasion 50% or greater (OR, 4.0), and positive peritoneal cytology (OR, 27) predicted extra-abdominal relapses. Compared with vaginal relapses, intra-abdominal relapses beyond the pelvis and extra-abdominal relapses were associated with a worse disease-specific survival. Survival of patients with a pelvic relapse did not differ from that of patients with a vaginal relapse.
Risk variables of endometrial cancer are differently associated with relapses in different locations. Our findings may promote studies that explore the most efficient adjuvant therapy in high-risk early-stage endometrioid endometrial cancer.
本研究旨在调查I-II期子宫内膜样腺癌患者中，晚期疾病和/或不良预后的预测因素与不同解剖部位肿瘤复发发生之间的关联。
本研究共纳入929例患者。中位随访时间为57个月（范围1 - 108个月）。研究变量包括：肿瘤分化差、肌层浸润达50%或以上、肿瘤大小达3 cm或以上、淋巴管间隙浸润、宫颈间质浸润、腹腔细胞学阳性、老年（>77岁）、肥胖（体重指数≥30 kg/m²）和糖尿病。
98例患者（10.5%）被诊断复发（阴道复发15例，盆腔复发27例，盆腔外腹腔内复发27例，腹腔外复发29例）。单因素分析中，没有变量与阴道或盆腔复发风险改变相关。肿瘤分化差、肌层浸润达50%或以上、肿瘤大小达3 cm或以上以及腹腔细胞学阳性与盆腔外腹腔内复发风险增加相关（比值比[OR]在2.2至9.6之间）。除肥胖和糖尿病外，所有变量均与腹腔外复发风险增加相关（OR在2.3至13之间）。多因素分析中，肿瘤大小达3 cm或以上（OR，3.1）和腹腔细胞学阳性（OR，16）预测盆腔外腹腔内复发，而肿瘤分化差（OR，2.9）、肌层浸润达50%或以上（OR，4.0）和腹腔细胞学阳性（OR，27）预测腹腔外复发。与阴道复发相比，盆腔外腹腔内复发和腹腔外复发与疾病特异性生存率较差相关。盆腔复发患者的生存率与阴道复发患者的生存率无差异。
子宫内膜癌的风险变量与不同部位复发的关联不同。我们的研究结果可能会推动探索高危早期子宫内膜样腺癌最有效辅助治疗的研究。
