Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069 Université François-Rabelais, Tours, France.
Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; UMR_S938 Sorbonne University, Paris, France.
Eur J Surg Oncol. 2019 Apr;45(4):672-678. doi: 10.1016/j.ejso.2019.01.011. Epub 2019 Jan 19.
Patterns of distant metastatic failure of endometrial cancer (EC) by specific anatomic site are not well described in the literature. In this manuscript, we evaluated the metastatic patterns of EC cancer and analysed the potential distribution of metastatic disease in this malignancy.
A total of 1444 women with EC were identified. Of which we extracted women with locoregional and distant recurrence or with distant recurrence alone. Women were scored based on first site of metastasis: multiple versus one site: bone, brain, lung, liver or sus diaphragmatic lymph nodes.
110 women developed distant metastatic disease with (n = 37(33.6%)) or without (n = 73(66.4%)) locoregional recurrence, including 39 women with exclusive first site of metastatic disease and 34 women with multiple sites of metastatic disease. When considering all women, the most common exclusive first site of metastasis was lung (42.8%). The median time to develop distant metastases was shorter after the completion of treatment for exclusive brain metastatic disease compared with other sites of metastatic- disease (7 months vs, 9 for lung, 10 for liver, 19 for bone and 27 months for sus-diaphragmatic LN; P = 0.004). The rate of 3-year overall survival was higher in the sus-diaphragmatic LN metastase group (83.3% vs 50.6% for lung, 37.3% for bone, 16.7% for brain and 0% for liver; P = 0.0059).
The present study has demonstrated the site-specific patterns of metastases. These data support current clinical practice of screening for site-specific metastatic disease after initial treatment of early stage EC based on concerning women-specific signs or symptoms.
子宫内膜癌（EC）远处转移失败的模式在文献中描述得并不清楚。在本文中，我们评估了 EC 癌症的转移模式，并分析了这种恶性肿瘤中转移性疾病的潜在分布。
共确定了 1444 名患有 EC 的女性。我们从中提取了局部和远处复发或仅远处复发的女性。根据转移的第一部位对女性进行评分：单发部位和多发部位：骨、脑、肺、肝或膈下游离淋巴结。
110 名女性发生了远处转移，其中 37 名（33.6%）有或无局部区域复发，73 名（66.4%）无局部区域复发，包括 39 名远处转移唯一部位为一处的女性和 34 名远处转移为多处的女性。考虑到所有女性，最常见的远处转移唯一部位是肺（42.8%）。与其他转移部位相比，完成治疗后出现脑转移的中位时间更短（7 个月 vs 肺为 9 个月，肝为 10 个月，骨为 19 个月，膈下游离淋巴结为 27 个月；P=0.004）。膈下游离淋巴结转移组的 3 年总生存率更高（83.3% vs 肺为 50.6%，骨为 37.3%，脑为 16.7%，肝为 0%；P=0.0059）。
本研究表明了转移的部位特异性模式。这些数据支持目前根据女性特定的体征或症状对早期 EC 初始治疗后进行特定部位转移性疾病筛查的临床实践。
