Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Int J Gynecol Cancer. 2019 Mar;29(3):497-504. doi: 10.1136/ijgc-2018-000056. Epub 2019 Jan 4.
To study recurrence rates in Danish high-risk stage I endometrial cancers not given radiotherapy in accordance with the decision of the Danish Gynecological Cancer Group.
This prospective national cohort study includes all 4707 endometrial carcinomas diagnosed from 2005 to 2012. Of these, 623 patients had grade 3 endometroid adenocarcinoma with >50% myometrial invasion or serous/clear/undifferentiated carcinoma (with any depth of invasion). In 305 patients with high-risk stage I on final pathology, 14.1% received adjuvant external beam radiotherapy and 9.6% adjuvant chemotherapy. No patients received brachytherapy. 5-year Kaplan-Meier survival estimates and actuarial recurrence rates were calculated, and adjusted Cox regression analysis used for comparison. Recurrence rates were compared with historical Danish population data (DEMCA 98-99).
For non-irradiated patients, 5-year overall survival, cancer-specific survival, and progression-free survival rates in high-risk stage I patients were 65%, 78%, and 73%, respectively. For non-irradiated patients, isolated local recurrences were uncommon (vaginal 3.1%, pelvic 0.4%). Death was mainly due to a high occurrence of non-local recurrences, with 8.8% experiencing a first recurrence in the abdominal cavity (outside the field where radiation traditionally have been given) and 13.0% a distant metastasis outside the abdominal cavity. Grade 3 tumors with >50% myometrial invasion seem to be characterized by a different pattern of recurrences, with significantly more isolated vaginal recurrences (7.9% vs 2.2%) and fewer total number of abdominal recurrences (7.9% vs 15.3%) as compared with unfavorable tumor types.
Isolated vaginal and pelvic recurrences were rare (3-5%) in patients with a final pathologic diagnosis of high-risk stage I endometrial cancer even after the Danish Gynecological Cancer Group decided to omit all types of postoperative radiotherapy and introduce lymph node staging.
研究丹麦妇科癌症组决定不给放疗的丹麦高危Ⅰ期子宫内膜癌的复发率。
这项前瞻性全国队列研究纳入了 2005 年至 2012 年间诊断的所有 4707 例子宫内膜癌患者。其中，623 例患者为高级别子宫内膜样腺癌，伴>50%的肌层浸润或浆液性/透明细胞/未分化癌（任何浸润深度）。在最终病理为高危Ⅰ期的 305 例患者中，14.1%接受了辅助外照射放疗，9.6%接受了辅助化疗。没有患者接受近距离放疗。计算了 5 年的 Kaplan-Meier 生存估计和实际复发率，并进行了调整后的 Cox 回归分析比较。将复发率与丹麦历史人群数据（DEMCA 98-99）进行了比较。
对于未放疗的患者，高危Ⅰ期患者的 5 年总生存率、癌症特异性生存率和无进展生存率分别为 65%、78%和 73%。对于未放疗的患者，孤立性局部复发罕见（阴道 3.1%，盆腔 0.4%）。死亡主要归因于非局部复发的高发生率，8.8%的患者首次在腹部（传统放疗照射野外）复发，13.0%的患者在腹部外发生远处转移。伴>50%肌层浸润的高级别肿瘤似乎具有不同的复发模式，孤立性阴道复发明显更多（7.9%比 2.2%），而总的腹部复发更少（7.9%比 15.3%）。
即使丹麦妇科癌症组决定省略所有类型的术后放疗并引入淋巴结分期，最终病理诊断为高危Ⅰ期子宫内膜癌的患者中，孤立性阴道和盆腔复发仍很少见（3-5%）。
