Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Weill Cornell Medical College, New York, NY, United States of America.
Gynecol Oncol. 2018 Dec;151(3):395-400. doi: 10.1016/j.ygyno.2018.09.021. Epub 2018 Oct 2.
To assess the rates and distribution of first recurrence in patients with FIGO stage IIIC1 endometrial cancer (EC) who did not undergo paraaortic dissection at surgical staging.
We retrospectively selected all (n = 207) stage IIIC1 patients treated at a single institution from 5/1993-1/2017. Sites of first recurrence were identified, disease-free (DFS) and overall survival (OS) calculated, multivariate logistic regression performed to identify factors associated with recurrence.
Three-year DFS and OS were 66.5% and 85.7%, respectively. The most common histology was endometroid (64.2%). Three-year DFS was 81% (SE±3.8%) endometrioid vs. 39.5% (SE±6.6%) non-endometrioid (P < 0.001). Three-year OS was 96.9% (SE±1.8%) endometrioid vs. 65.6% (SE±6.7%) non-endometrioid (P < 0.001). Sixty-two (30.1%) patients recurred. Patterns of recurrence were: 14 (8.3%) multiple sites, 17 (8.2%) abdominal, 14 (6.8%) extra-abdominal, 17 (8.3%) isolated nodal (8 of these (3.9%) paraaortic). Patients with isolated tumor cells (ITCs) in lymph nodes only had 12/71 (17%) recurrence rate vs. 50/135 (37%) for patients with micro-/macrometastasis. On univariate analysis, grade (HR 4.67 95%CI 1.5-14.5, P = 0.008), histology (HR 4.9 95%CI 2.6-9.3, P < 0.001), myometrial invasion (HR 1.9 95%CI 1.04-3.5, P = 0.04), pelvic washing (HR 2.2 95%CI 1.1-4.5, P = 0.03), tumor volume in pelvic LNs (ITC vs. micro-/macrometastasis; HR 0.3 95%CI 0.2-0.7, P = 0.003) were associated with recurrence. On multivariate analysis, only histology was associated with recurrence (HR 7.88 95%CI 3.43-18.13, P < 0.001).
Isolated paraaortic recurrence in stage IIIC1 EC is uncommon. Micro-/macrometastasis were associated with twice the recurrence rate compared to ITC. These data will help clinicians counsel patients with stage IIIC1 EC regarding paraaortic assessment.
评估在手术分期时未行腹主动脉旁清扫术的 FIGO 分期 IIIC1 子宫内膜癌（EC）患者首次复发的发生率和分布情况。
我们回顾性地选择了 2017 年 1 月 1 日前在一家机构治疗的所有（n=207）IIIC1 期患者。确定了首次复发的部位，计算了无病生存（DFS）和总生存（OS），并进行了多变量逻辑回归以确定与复发相关的因素。
三年 DFS 和 OS 分别为 66.5%和 85.7%。最常见的组织学类型是子宫内膜样（64.2%）。三年 DFS 为 81%（SE±3.8%）子宫内膜样 vs. 39.5%（SE±6.6%）非子宫内膜样（P<0.001）。三年 OS 为 96.9%（SE±1.8%）子宫内膜样 vs. 65.6%（SE±6.7%）非子宫内膜样（P<0.001）。62（30.1%）例患者复发。复发模式为：14 例（8.3%）为多个部位，17 例（8.2%）为腹部，14 例（6.8%）为腹外，17 例（8.3%）为孤立性淋巴结（其中 8 例（3.9%）为腹主动脉旁）。仅淋巴结有肿瘤细胞（ITC）的患者复发率为 12/71（17%），而微/大转移患者的复发率为 50/135（37%）。单因素分析显示，分级（HR 4.67 95%CI 1.5-14.5，P=0.008）、组织学（HR 4.9 95%CI 2.6-9.3，P<0.001）、肌层浸润（HR 1.9 95%CI 1.04-3.5，P=0.04）、盆腔冲洗（HR 2.2 95%CI 1.1-4.5，P=0.03）、盆腔淋巴结肿瘤体积（ITC 与微/大转移；HR 0.3 95%CI 0.2-0.7，P=0.003）与复发相关。多因素分析显示，只有组织学与复发相关（HR 7.88 95%CI 3.43-18.13，P<0.001）。
在 IIIC1 期 EC 中，孤立性腹主动脉旁复发并不常见。微/大转移与 ITC 相比，复发率增加了一倍。这些数据将有助于临床医生向 IIIC1 期 EC 患者提供有关腹主动脉评估的咨询。
