Sahin Hanifi, Meydanli Mehmet Mutlu, Sari Mustafa Erkan, Kocaman Eda, Cuylan Zeliha Firat, Yalcin Ibrahim, Coban Gonca, Özen Özlem, Sirvan Levent, Güngör Tayfun, Ayhan Ali
Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey.
Taiwan J Obstet Gynecol. 2019 Jan;58(1):82-89. doi: 10.1016/j.tjog.2018.11.016.
The purpose of this study was to determine the patterns of failure and prognostic factors for lymphovascular space invasion (LVSI)-positive endometrioid endometrial cancer (EC) patients in the setting of negative lymph nodes (LNs).
A multicenter, retrospective department database review was performed to identify LVSI-positive patients with disease surgically confined to the uterus at two gynecologic oncology centers in Turkey. Demographic, clinicopathological and survival data were collected.
We identified 185 LVSI-positivewomen with negative LNs during the study period. Fifty-five (29.7%) were classified as Stage IA, 94 (50.8%) as Stage IB, and 36 (19.5%) as Stage II. The median age at diagnosis was 59 years and the median duration of follow-up was 44 months. The total number of the recurrences was 12 (6.5%). We observed 5 (2.9%) loco-regional recurrences, 3 (1.5%) retroperitoneal failures, and 4 (2.0%) distant relapses. The 5-year progression-free survival (PFS) was 86.1% while the 5-year overall survival (OS) rate was 87.7%. Grade 3 histology (Hazard Ratio [HR] 2.9, 95% Confidence Interval [CI] 1.02-8.50; p = 0.04), cervical stromal invasion (HR 4.5, 95% CI 1.61-12.79; p = 0.004) and age ≥ 60 years (HR 5.8, 95% CI 1.62-21.32; p = 0.007) were found to be independent prognostic factors for decreased OS. Adjuvant treatment did not appear as a prognostic factor for OS even in univariate analysis.
The recurrence rate among LVSI-positive endometrioid EC patients is low in the setting of negative LNs. However, one out of three patients with a recurrence experiences distant relapses which usually portend worse outcomes.
本研究旨在确定在淋巴结阴性情况下，淋巴管间隙浸润（LVSI）阳性的子宫内膜样子宫内膜癌（EC）患者的失败模式和预后因素。
对土耳其两家妇科肿瘤中心的多中心回顾性科室数据库进行分析，以确定手术局限于子宫的LVSI阳性患者。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185例LVSI阳性且淋巴结阴性的女性患者。其中55例（29.7%）为IA期，94例（50.8%）为IB期，36例（19.5%）为II期。诊断时的中位年龄为59岁，中位随访时间为44个月。复发总数为12例（6.5%）。我们观察到5例（2.9%）局部区域复发，3例（1.5%）腹膜后失败，4例（2.0%）远处复发。5年无进展生存率（PFS）为86.1%，5年总生存率（OS）为87.7%。组织学3级（风险比[HR]2.9，95%置信区间[CI]1.02 - 8.50；p = 0.04）、宫颈间质浸润（HR 4.5，95%CI 1.61 - 12.79；p = 0.004）和年龄≥60岁（HR 5.8，95%CI 1.62 - 21.32；p = 0.007）被发现是OS降低的独立预后因素。即使在单因素分析中，辅助治疗也未表现为OS的预后因素。
在淋巴结阴性的情况下，LVSI阳性的子宫内膜样EC患者的复发率较低。然而，三分之一复发患者会发生远处复发，这通常预示着更差的预后。
