复发性子宫内膜癌分类建议：来自 FRANCOGYN 研究组的法国多中心数据库分析。
A Proposal for a Classification for Recurrent Endometrial Cancer: Analysis of a French Multicenter Database From the FRANCOGYN Study Group.
机构信息
Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris, University Paris 13.
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie.
出版信息
Int J Gynecol Cancer. 2018 Sep;28(7):1278-1284. doi: 10.1097/IGC.0000000000001296.
OBJECTIVE
Endometrial cancer (EC) recurrences are relatively common with no standardized way of describing them. We propose a new classification for them called locoregional, nodal, metastasis, carcinomatosis recurrences (rLMNC).
PATIENTS AND METHODS
The data of 1230 women with EC who were initially treated by primary surgery were included in this French multicenter retrospective study. Recurrences were classified based on dissemination pathways: (1) locoregional recurrence (rL); (2) nodal recurrence (rN) for lymphatic pathway; (3) distant organ recurrence (rM) for hematogenous pathway; and (4) carcinomatosis recurrence (rC) for peritoneal pathway. These pathways were further divided into subgroups. We compared recurrence free survival and overall survival (OS) between the 4 groups (rL/rN/rM/rC).
RESULTS
The median follow-up was 35.6 months (range, 1.70-167.60). One hundred ninety-eight women (18.2%) experienced a recurrence: 150 (75.8%) experienced a single-pathway recurrence and 48 (24.2%) a multiple-pathway recurrence. The 5-year OS was 34.1% (95% confidence interval [CI], 27.02%-43.1%), and the median time to first recurrence was 18.9 months (range, 0-152 months). The median survival after recurrence was 14.8 months (95% CI, 11.7-18.8). Among women with single pathway of recurrence, a difference in 5-year OS (P < 0.001) and survival after recurrence (P < 0.01) was found between the 4 rLNMC groups. The carcinomatosis group had the worst prognosis compared with other single recurrence pathways. Women with multiple recurrences had poorer 5-year OS (P < 0.001) and survival after recurrence (P < 0.01) than those with single metastasis recurrence, other than women with peritoneal carcinomatosis.
CONCLUSIONS
This easy-to-use and intuitive classification may be helpful to define EC recurrence risk groups and develop guidelines for the management of recurrence. Its prognosis value could also be a tool to select homogenous populations for further trials.
目的
子宫内膜癌（EC）的复发较为常见，但目前尚无标准化的描述方法。我们提出了一种新的分类方法，称为局部区域、淋巴结、转移、癌性播散复发（rLMNC）。
方法
本研究纳入了法国多中心回顾性研究中 1230 例初始接受根治性手术治疗的 EC 患者的数据。根据传播途径对复发进行分类：（1）局部区域复发（rL）；（2）淋巴结复发（rN），通过淋巴途径；（3）远处器官复发（rM），通过血液途径；（4）癌性播散复发（rC），通过腹膜途径。这些途径进一步分为亚组。我们比较了 4 组（rL/rN/rM/rC）之间的无复发生存率和总生存率（OS）。
结果
中位随访时间为 35.6 个月（范围 1.70-167.60）。198 例患者（18.2%）出现复发：150 例（75.8%）为单途径复发，48 例（24.2%）为多途径复发。5 年 OS 为 34.1%（95%置信区间[CI]，27.02%-43.1%），首次复发的中位时间为 18.9 个月（范围 0-152 个月）。复发后的中位生存时间为 14.8 个月（95%CI，11.7-18.8）。在单途径复发的患者中，4 组 rLNMC 之间的 5 年 OS（P < 0.001）和复发后生存（P < 0.01）存在差异。与其他单复发途径相比，癌性播散组的预后最差。与单转移复发患者相比，具有多次复发的患者的 5 年 OS（P < 0.001）和复发后生存（P < 0.01）较差，除了腹膜癌性播散患者。
结论
这种易于使用和直观的分类方法可能有助于确定 EC 复发风险组，并制定复发管理指南。其预后价值也可以作为选择同质人群进行进一步试验的工具。
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