Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
Gynecol Oncol. 2020 May;157(2):335-339. doi: 10.1016/j.ygyno.2020.02.003. Epub 2020 Feb 20.
To evaluate the role of radical hysterectomy in the management of patients with stage II endometrial carcinoma.
Patients diagnosed between 2004 and 2015, with stage II (based on the revised FIGO staging) endometrial carcinoma who had hysterectomy and regional lymph node surgery were identified in the National Cancer Database. Those who had radical or modified radical (RH), or total hysterectomy (TH) were selected. Overall survival (OS) was assessed with Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to evaluate survival after controlling for confounders.
A total of 7552 patients who met the inclusion criteria were identified. Rate of RH was 10.5%. Those who underwent RH had longer hospital stay (median 3 vs 2 days, p < 0.001) and a higher 90-day (1.6% vs 0.8%, p = 0.05) mortality. There was no difference in OS between patients who had RH (n = 712) and SH (n = 5955) (p = 0.62); 5-year survival rates were 77.4% and 76.9%, respectively. After controlling for patient age (<65, ≥65 years), race (white, black, other/unknown), insurance status, presence of comorbidities, tumor size (<5, ≥5 cm, unknown), histology (endometrioid, non-endometrioid), performance of adequate lymphadenectomy, and receipt of adjuvant chemotherapy and radiation therapy, performance of radical hysterectomy was not associated with better survival (HR: 1.01, 95% CI: 0.85, 1.21).
Radical hysterectomy was not associated with a survival benefit in a cohort of patients with stage II endometrial carcinoma.
评估根治性子宫切除术在治疗 II 期子宫内膜癌患者中的作用。
在国家癌症数据库中，确定了 2004 年至 2015 年间诊断为 II 期（基于修订后的 FIGO 分期）子宫内膜癌并接受子宫切除术和区域淋巴结手术的患者。选择接受根治性或改良根治性（RH）或全子宫切除术（TH）的患者。使用 Kaplan-Meier 曲线评估总生存期（OS），并通过对数秩检验进行比较。构建 Cox 模型以评估控制混杂因素后的生存情况。
共纳入符合条件的 7552 例患者。RH 率为 10.5%。接受 RH 的患者住院时间更长（中位数 3 天比 2 天，p<0.001），90 天死亡率更高（1.6%比 0.8%，p=0.05）。接受 RH（n=712）和 SH（n=5955）的患者 OS 无差异（p=0.62）；5 年生存率分别为 77.4%和 76.9%。在控制患者年龄（<65 岁，≥65 岁）、种族（白人、黑人、其他/未知）、保险状况、合并症存在情况、肿瘤大小（<5cm，≥5cm，未知）、组织学（子宫内膜样、非子宫内膜样）、充分的淋巴结切除术和接受辅助化疗和放疗后，根治性子宫切除术与更好的生存无关（HR：1.01，95%CI：0.85，1.21）。
在 II 期子宫内膜癌患者队列中，根治性子宫切除术与生存获益无关。
