Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Hospital, Philadelphia, PA, USA.
Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
Arch Gynecol Obstet. 2019 Aug;300(2):389-394. doi: 10.1007/s00404-019-05187-9. Epub 2019 May 8.
Radiation exposure has long been established as a risk factor for cancer development. The purpose of this study is to assess the risk of uterine malignancy in patients previously treated for cervical cancer with radiation therapy.
A population-based cohort of 9092 patients diagnosed with cervical cancer who did not undergo surgery and received radiation therapy between 1973 and 2008 was identified from the Surveillance, Epidemiology and End Results Program database (SEER 9). Patients in this cohort who developed endometrial cancer after treatment of cervical cancer were identified. 55,140 patients with endometrial cancer were also identified. The distribution of the different histologic types of endometrial cancer was determined for each of these cohorts.
54 patients (0.6%) were diagnosed with an endometrial cancer more than 12 months after diagnosis of cervical cancer. The average latency to endometrial cancer diagnosis was 160 months, with a range of 14-374 months. The average age of cervical cancer diagnosis was 52 years and the average age at subsequent endometrial cancer diagnosis was 66 years. Only 40% of the endometrial cancers diagnosed following treatment of cervical cancer were endometrioid. The majority were clear-cell adenocarcinomas (42%), 9% were carcinosarcomas and 5.5% were leiomyosarcomas. Of the 55,140 endometrial cancer patients in the database, a vast majority were endometrioid adenocarcinomas (91%), and only 2.3% clear-cell adenocarcinoma, 2.3% carcinosarcoma and 0.5% leiomyosarcoma. The difference in histologic type distribution between these two cohorts is highly significant (p < 0.01).
A small proportion of women who receive radiation for cervical cancer go on to develop endometrial cancer. These are predominantly of the more aggressive histologic types when compared to primary endometrial cancers. The latency from cervical cancer diagnosis to endometrial cancer diagnosis is over a decade. In a patient who still has a uterus after receiving pelvic radiation, vaginal bleeding should be investigated.
辐射暴露早已被确定为癌症发展的一个风险因素。本研究的目的是评估先前接受宫颈癌放射治疗的患者发生子宫恶性肿瘤的风险。
从监测、流行病学和最终结果计划（SEER 9）数据库中确定了 9092 名在 1973 年至 2008 年期间未接受手术且接受放射治疗的宫颈癌患者的人群队列。在该队列中，对治疗宫颈癌后发生子宫内膜癌的患者进行了识别。还确定了 55140 名患有子宫内膜癌的患者。确定了这些队列中不同组织学类型子宫内膜癌的分布。
54 名患者（0.6%）在宫颈癌诊断后 12 个月以上被诊断患有子宫内膜癌。子宫内膜癌诊断的平均潜伏期为 160 个月，范围为 14-374 个月。宫颈癌诊断的平均年龄为 52 岁，随后子宫内膜癌诊断的平均年龄为 66 岁。仅 40%的宫颈癌治疗后诊断的子宫内膜癌为子宫内膜样腺癌。大多数为透明细胞腺癌（42%），9%为癌肉瘤，5.5%为平滑肌肉瘤。在数据库中的 55140 名子宫内膜癌患者中，绝大多数为子宫内膜样腺癌（91%），仅有 2.3%为透明细胞腺癌，2.3%为癌肉瘤，0.5%为平滑肌肉瘤。这两个队列之间的组织学类型分布差异具有统计学意义（p<0.01）。
接受宫颈癌放射治疗的女性中，只有一小部分会发展为子宫内膜癌。与原发性子宫内膜癌相比，这些癌主要是更具侵袭性的组织学类型。从宫颈癌诊断到子宫内膜癌诊断的潜伏期超过十年。在接受盆腔放疗后仍有子宫的患者中，应调查阴道出血。
