Cuylan Zeliha F, Oz Murat, Ozkan Nazli T, Comert Gunsu K, Sahin Hanifi, Turan Taner, Akbayir Ozgur, Kuscu Esra, Celik Husnu, Dede Murat, Gungor Tayfun, Meydanli Mehmet M, Ayhan Ali
Department of Gynecologic Oncology, Faculty of Medicine, Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Department of Gynecologic Oncology, Faculty of Medicine, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
J Obstet Gynaecol Res. 2018 Jun;44(6):1140-1149. doi: 10.1111/jog.13615. Epub 2018 Mar 8.
The purpose of this study was to determine the prognostic factors and patterns of failure in lymphovascular space invasion (LVSI)-positive women with stage IIIC endometrioid endometrial cancer (EC).
A multicenter, retrospective, department database review was performed to identify LVSI-positive patients with stage IIIC endometrioid EC at five gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected.
We identified 172 LVSI-positive women with stage IIIC endometrioid EC during the study period; 75 (43.6%) were classified as Stage IIIC and 97 (56.4%) as Stage IIIC . The median age at diagnosis was 59 years, and the median duration of follow up was 34.5 months. The total number of recurrences was 46 (26.7%). We observed 14 (8.1%) locoregional recurrences, 12 (7.0%) retroperitoneal failures and 20 (11.6%) distant relapses. For the entire study cohort, 5-year progression-free survival (PFS) was 67.4%, while the 5-year overall survival (OS) rate was 75.1%. Grade 3 histology (hazard ratio [HR] 2.62, 95% confidence interval [CI] 1.34-5.12; P = 0.005), cervical stromal invasion (HR 2.33, 95% CI 1.09-4.99; P = 0.028) and myometrial invasion (MMI) ≥50% (HR 4.0, 95% CI 1.16-13.69; P = 0.028) were found to be independent prognostic factors for decreased OS.
Uterine factors such as grade 3 disease, cervical stromal invasion and deep MMI seem to be independently associated with decreased OS in LVSI-positive women with stage IIIC endometrioid EC. The high distant recurrence rate in this subgroup of patients warrants further studies in order to identify the most effective treatment strategy for those patients.
本研究旨在确定IIIC期子宫内膜样子宫内膜癌（EC）且伴有淋巴血管间隙浸润（LVSI）的女性患者的预后因素及失败模式。
通过对土耳其五个妇科肿瘤中心的科室数据库进行多中心、回顾性研究，以确定IIIC期子宫内膜样EC且LVSI阳性的患者。收集人口统计学、临床病理和生存数据。
在研究期间，我们共确定了172例IIIC期子宫内膜样EC且LVSI阳性的女性患者；其中75例（43.6%）被归类为IIIC1期，97例（56.4%）为IIIC2期。诊断时的中位年龄为59岁，中位随访时间为34.5个月。复发总数为46例（26.7%）。我们观察到14例（8.1%）局部区域复发、12例（7.0%）腹膜后失败和20例（11.6%）远处复发。对于整个研究队列，5年无进展生存率（PFS）为67.4%，而5年总生存率（OS）为75.1%。组织学3级（风险比[HR] 2.62，95%置信区间[CI] 1.34 - 5.12；P = 0.005）、宫颈间质浸润（HR 2.33，95% CI 1.09 - 4.99；P = 0.028）和肌层浸润（MMI）≥50%（HR 4.0，95% CI 1.16 - 13.69；P = 0.028）被发现是OS降低的独立预后因素。
子宫因素如3级疾病、宫颈间质浸润和深度MMI似乎与IIIC期子宫内膜样EC且LVSI阳性的女性患者OS降低独立相关。该亚组患者的高远处复发率值得进一步研究，以确定针对这些患者最有效的治疗策略。
