Jung Jinhong, Kim Young Seok, Joo Ji Hyeon, Park Won, Lee Jong-Hoon, Kim Jin Hee, Yoon Won Sup, Lee Seok-Ho, Eom Keun-Yong, Kim Yong Bae
*Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; †Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; ‡Department of Radiation Oncology, St Vincent's Hospital, The Catholic University of Korea, College of Medicine, Suwon; §Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu; ∥Department of Radiation Oncology, Korea University Ansan Hospital, Ansan; ¶Department of Radiation Oncology, Gil Medical Center, Gachon Medical School, Incheon; #Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam; and **Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Int J Gynecol Cancer. 2017 Sep;27(7):1387-1392. doi: 10.1097/IGC.0000000000001030.
The aim of this study was to investigate the survival, patterns of failure, and prognostic factors in patients with stage II endometrial carcinoma treated with adjuvant radiotherapy.
We reviewed the medical records of patients who underwent total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection followed by adjuvant radiotherapy in 10 participating hospitals of the Korean Radiation Oncology Group. Most patients received adjuvant external beam radiation therapy, with a median dose of 50.4 Gy; approximately 50% of these patients received an additional brachytherapy boost, with a median dose of 18 Gy. Adjuvant chemotherapy was administered to 19 patients.
A total of 122 patients were examined. Over a median follow-up period of 62.7 months (range, 1.9-158.8 months), the 5-year overall survival (OS) and disease-free survival rates were found to be 91.1% and 85.1%, respectively. Recurrence was observed in 14 patients (11.5%), including 3 with local recurrence and 11 with distant metastases as the first site of recurrence. Univariate analysis indicated that lymphovascular invasion was related to an unfavorable OS. An age of 60 years or above, histologic grade 3, and lymphovascular invasion were identified as risk factors for OS. Because there were several risk factors related to OS, we assigned patients to a high-risk group (defined as cases with ≥1 risk factors) and a low-risk group. The 5-year OS rate of the high-risk group was significantly inferior to that of the low-risk group (82.9% vs 100%, P = 0.003).
The high-risk group had a significantly poorer survival rate than the low-risk group, and distant metastasis was the main pattern of recurrence, thus indicating that further adjuvant chemotherapy should be considered in high-risk patients.
本研究旨在调查接受辅助放疗的Ⅱ期子宫内膜癌患者的生存率、失败模式及预后因素。
我们回顾了韩国放射肿瘤学组10家参与研究医院中接受全子宫切除术、双侧输卵管卵巢切除术及盆腔淋巴结清扫术并随后接受辅助放疗的患者的病历。大多数患者接受辅助外照射放疗，中位剂量为50.4 Gy；其中约50%的患者额外接受了近距离放疗增敏，中位剂量为18 Gy。19例患者接受了辅助化疗。
共检查了122例患者。在中位随访期62.7个月（范围1.9 - 158.8个月）内，5年总生存率（OS）和无病生存率分别为91.1%和85.1%。14例患者（11.5%）出现复发，其中3例为局部复发，11例以远处转移作为首发复发部位。单因素分析表明，脉管浸润与不良的总生存率相关。60岁及以上年龄、组织学3级和脉管浸润被确定为总生存率的危险因素。由于存在多个与总生存率相关的危险因素，我们将患者分为高危组（定义为具有≥1个危险因素的病例）和低危组。高危组的5年总生存率显著低于低危组（82.9%对100%，P = 0.003）。
高危组的生存率明显低于低危组，远处转移是主要的复发模式，这表明高危患者应考虑进一步的辅助化疗。
