Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecol Oncol. 2019 Jan;152(1):38-45. doi: 10.1016/j.ygyno.2018.10.033. Epub 2018 Nov 6.
Determining whether carcinomas concurrently involving endometrium and ovary are independent primary tumors (IPTs) or endometrial carcinomas with ovarian metastases (at least stage IIIA endometrial cancers, IIIA-EC) using clinicopathologic criteria is often challenging. Recent genomic studies showed that most such tumors are clonally related. We sought to identify clinicopathologic features associated with clinical outcomes, and to separate women with these tumors into clinically low-risk and high-risk groups.
We reviewed clinical and pathologic data from 74 women who, between 1993 and 2014, underwent primary surgery for endometrial cancer and had concurrent ovarian involvement.
The endometrial carcinomas were endometrioid (EECs, n = 41) or non-endometrioid (ENECs, n = 33). Nineteen (26%) cases were originally classified as IPTs using clinicopathologic criteria. Multivariate analysis revealed that lymph node involvement (hazard ratio (HR) = 2.38, 95% CI 1.13-5.02, p = 0.023) and non-endometrioid endometrial tumor histology (HR = 6.27, 95% CI 2.6-15.13, p < 0.001) were associated with poorer progression-free survival (PFS). Multivariate analysis of 65 women with known lymph node status revealed two prognostically distinct groups: a high-risk group comprising ENECs with ≥50% myometrial invasion irrespective of lymph node status (n = 21; median PFS 12.7 months, 95% CI, 9.24-19.8); and a low-risk group consisting of all EECs, as well as lymph node-negative ENECs with <50% myometrial invasion (n = 44, median PFS not reached). The risk-based classification was superior to the original classification of endometrial cancers as IPTs vs. IIIA-EC for predicting PFS (log-rank test, p < 0.001 vs. p = 0.07).
Our proposed risk-based stratification enables categorization of women with concurrent endometrial and ovarian tumors according to their likely clinical outcomes.
使用临床病理标准确定同时累及子宫内膜和卵巢的癌是否为独立原发性肿瘤（IPT）或子宫内膜癌伴卵巢转移（至少 IIIA 期子宫内膜癌，IIIA-EC）通常具有挑战性。最近的基因组研究表明，此类肿瘤大多数为克隆相关。我们试图确定与临床结局相关的临床病理特征，并将患有此类肿瘤的女性分为临床低危和高危组。
我们回顾了 1993 年至 2014 年间接受子宫内膜癌初次手术且同时伴有卵巢受累的 74 名女性的临床和病理数据。
子宫内膜癌为内膜样（EECs，n=41）或非内膜样（ENECs，n=33）。19 例（26%）病例最初根据临床病理标准分类为 IPT。多变量分析显示，淋巴结受累（风险比（HR）=2.38，95%CI 1.13-5.02，p=0.023）和非内膜样子宫内膜肿瘤组织学（HR=6.27，95%CI 2.6-15.13，p<0.001）与无进展生存期（PFS）较差相关。对 65 名已知淋巴结状态的女性进行多变量分析，结果显示存在两组预后明显不同的患者：高危组包括无论淋巴结状态如何，ENECs 中≥50%的子宫肌层浸润（n=21；中位 PFS 12.7 个月，95%CI，9.24-19.8）；低危组包括所有 EECs 以及淋巴结阴性的 ENECs 中<50%的子宫肌层浸润（n=44，中位 PFS 未达到）。基于风险的分类对于预测 PFS 优于子宫内膜癌的原始分类为 IPT 与 IIIA-EC（对数秩检验，p<0.001 与 p=0.07）。
我们提出的基于风险的分层方法能够根据可能的临床结局对同时患有子宫内膜和卵巢肿瘤的女性进行分类。
