Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara.
Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara.
Int J Gynecol Cancer. 2018 Oct;28(8):1616-1623. doi: 10.1097/IGC.0000000000001346.
Chemotherapy is a standard adjuvant treatment after primary surgery for endometrial cancer in Japan. We aimed to characterize the clinical features of recurrent endometrial cancer (REC) patients in Japan.
We retrospectively reviewed the medical records of 112 REC patients who were primarily treated at 1 of 3 university hospitals in Japan from 2005 to 2012. We analyzed overall survival since the first recurrence (R-OS) in accordance with several factors.
Median patient age was 64 years. The median follow-up period was 48 months. The distributions of cancer stage and histological subtype lacked distinctive features, and most patients had a high risk for recurrence at the time of the primary surgery. Although approximately 78% of patients received adjuvant chemotherapy, 85/112 patients (76%) experienced recurrence within 2 years after the initial treatment ended. For patients receiving adjuvant chemotherapy, regional lymph node (LN) and distant-site recurrence were more frequent (>40%) than vaginal or intra-abdominal recurrence. Median survival and 5-year R-OS were 27 months and 26.1%, respectively. The R-OS was significantly better for patients aged 65 years or older, those with negative peritoneal cytology at the time of primary surgery, those with recurrence within regional LN (eg, pelvic LN or para-aortic LN under the renal vein) and/or vagina, and those who underwent surgery and/or radiotherapy after recurrence. A multivariate analysis indicated that positive peritoneal cytology, a disease-free interval of less than 12 months, recurrent lesions in 2 or 3 areas, and treatment excluding surgery or radiotherapy were independent predictors of poor prognosis after recurrence.
Adjuvant chemotherapy was insufficient to reduce the incidence of distant recurrence. The prognosis of patients recurred within regional LN and/or vagina was significantly better than that of patients with recurrence in other lesions because of treatment with surgery and/or radiotherapy. The disease-free interval was a significant prognostic factor for REC patients.
在日本，化学疗法是子宫内膜癌患者术后标准辅助治疗方法。本研究旨在分析日本复发性子宫内膜癌（REC）患者的临床特征。
回顾性分析 2005 年至 2012 年在日本 3 所大学医院之一接受初始治疗的 112 例 REC 患者的病历资料。根据不同因素分析首次复发后总生存期（R-OS）。
患者中位年龄为 64 岁。中位随访时间为 48 个月。癌症分期和组织学亚型的分布无明显特征，大多数患者在初始手术时就具有较高的复发风险。尽管约 78%的患者接受了辅助化疗，但仍有 85/112 例（76%）患者在初始治疗结束后 2 年内复发。对于接受辅助化疗的患者，区域淋巴结（LN）和远处部位复发的比例较高（>40%），而阴道或腹内复发的比例较低。中位生存时间和 5 年 R-OS 分别为 27 个月和 26.1%。年龄≥65 岁、初始手术时腹膜细胞学检查阴性、复发部位局限于 LN（如盆腔 LN 或肾静脉下方的腹主动脉旁 LN）和/或阴道、以及复发后接受手术和/或放疗的患者 R-OS 明显较好。多因素分析表明，腹膜细胞学阳性、无疾病间隔时间<12 个月、复发部位为 2 个或 3 个及以上、未接受手术或放疗治疗是复发后预后不良的独立预测因素。
辅助化疗不足以降低远处复发的发生率。复发部位局限于 LN 和/或阴道的患者预后明显优于其他部位复发的患者，这是因为采用了手术和/或放疗。无疾病间隔时间是 REC 患者的重要预后因素。
