Matsuo Koji, Machida Hiroko, Stone Rebecca L, Soliman Pamela T, Thaker Premal H, Roman Lynda D, Wright Jason D
Division of Gynecologic Oncology and Department of Obstetrics and Gynecology and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, John Hopkins Medicine, Baltimore, Maryland; the Department of Gynecologic Oncology and Reproductive Medicine, the University of Texas, MD Anderson Cancer Center, Houston, Texas; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York.
Obstet Gynecol. 2017 Aug;130(2):403-410. doi: 10.1097/AOG.0000000000002142.
To examine the cumulative incidence of subsequent ovarian cancer among young women with stage I endometrioid endometrial cancer who had ovarian conservation at surgical treatment.
This retrospective study examined the Surveillance, Epidemiology, and End Results Program to identify women aged younger than 50 years who underwent hysterectomy with ovarian conservation for stage I endometrioid endometrial cancer between 1983 and 2013. Time-dependent risk of ovarian cancer diagnosed during the follow-up after endometrial cancer diagnosis was examined.
Among 1,322 women in the study cohort, 16 women developed subsequent ovarian cancer with 5- and 10-year cumulative incidences of 1.0% and 1.3%, respectively. Median time to develop subsequent ovarian cancer was 2.4 years, and the majority of subsequent ovarian cancer was diagnosed within the first 3 years from the diagnosis of endometrial cancer (68.8%). The majority of subsequent ovarian cancer was endometrioid type (81.3%) and stage I disease (75.0%). With a median follow-up time of 11.6 years, there were no ovarian cancer deaths. Younger age at endometrial cancer diagnosis was significantly associated with increased risk of subsequent ovarian cancer (10-year cumulative incidences: age younger than 40 compared with 40-49 years, 2.6% compared with 0.4%, hazard ratio 5.00, 95% confidence interval [CI] 1.60-15.7, P=.002).
Young women with stage I endometrioid endometrial cancer have an approximately 1% risk of developing subsequent ovarian cancer after ovarian conservation at the time of hysterectomy that was associated with favorable tumor factors resulting in good ovarian cancer-specific survival. Our results endorse the importance of genetic testing and close follow-up when counseling about this procedure, especially for those who are younger than 40 years.
研究接受手术治疗时保留卵巢的Ⅰ期子宫内膜样腺癌年轻女性后续发生卵巢癌的累积发病率。
这项回顾性研究利用监测、流行病学和最终结果计划，识别1983年至2013年间因Ⅰ期子宫内膜样腺癌接受子宫切除并保留卵巢的50岁以下女性。研究了子宫内膜癌诊断后随访期间诊断出卵巢癌的时间依赖性风险。
在研究队列的1322名女性中，有16名女性发生了后续卵巢癌，5年和10年累积发病率分别为1.0%和1.3%。发生后续卵巢癌的中位时间为2.4年，大多数后续卵巢癌在子宫内膜癌诊断后的前3年内被诊断出来（68.8%）。大多数后续卵巢癌为子宫内膜样类型（81.3%）且为Ⅰ期疾病（75.0%）。中位随访时间为11.6年，无卵巢癌死亡病例。子宫内膜癌诊断时年龄较小与后续卵巢癌风险增加显著相关（10年累积发病率：40岁以下与40-49岁相比，2.6%与0.4%，风险比5.00，95%置信区间[CI]1.60-15.7，P=0.002）。
Ⅰ期子宫内膜样腺癌年轻女性在子宫切除时保留卵巢后，发生后续卵巢癌的风险约为1%，这与良好的肿瘤因素相关，导致卵巢癌特异性生存率良好。我们的结果支持在咨询该手术时进行基因检测和密切随访的重要性，尤其是对于40岁以下的女性。
