淋巴结切除术在 III&IV 期子宫浆液性癌患者中的作用：多中心土耳其研究结果。

The role of lymphadenectomy in patients with stage III&IV uterine serous carcinoma: Results of multicentric Turkish study.

机构信息

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

出版信息

J Gynecol Obstet Hum Reprod. 2021 May;50(5):102063. doi: 10.1016/j.jogoh.2021.102063. Epub 2021 Jan 13.

DOI:10.1016/j.jogoh.2021.102063

PMID:33453448

Abstract

OBJECTIVE

The aim of this study was to evaluate clinicopathological features, oncological outcome and prognostic factors for recurrence in advanced stage uterine serous carcinoma (USC) patients.

METHODS

Patients with 2009 International Federation of Gynecology and Obstetrics stage III&IV uterine serous carcinoma were enrolled from 4 gynecologic oncology centers and a study group was created. Response to therapy was evaluated according to the WHO criteria. Progression-free survival (PFS) and overall survival (OS) estimates were determinated by using the Kaplan-Meier method. Survival curves were compared with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model.

RESULTS

Entire cohort included 63 patients. Median age of cohort was 64 years. Thirty-five (55.6 %) patients were stage IV. Lymphadenectomy was performed in 57 (90.5 %) patients and lymph node metastasis was positive in 45 (71.4 %) patients. Maximal cytoreduction (no residue tumor) was achieved in 53 (84.1 %) patients. However, optimal cytoreduction (residue tumor ≤1 cm) was achieved in 6 (9.5 %) patients and suboptimal cytoreduction (residue tumor >1 cm) was achieved in 3 (4.8 %) patients. Median follow-up time was 19 (range;1-152) months. Complete clinical response was obtained in 58 (92.1 %) patients after standard adjuvant therapy. Disease failure was detected in 25 patients. Study group had a 2-year PFS of 51 % and 2-year OS of 80 %. On multivariate analysis, performing lymphadenectomy was an independent prognostic factor for PFS (Odds ratio: 24.794, 95 % Confidence Interval: 4.214-145.869; p < 0.001).

CONCLUSION

Lymphadenectomy should be a part of the standard surgical therapy in advanced stage USC.

摘要

目的

本研究旨在评估晚期子宫浆液性癌（USC）患者的临床病理特征、肿瘤学结局和复发的预后因素。

方法

从 4 个妇科肿瘤中心招募了 2009 年国际妇产科联合会（FIGO）III&IV 期子宫浆液性癌患者，并创建了一个研究组。根据世界卫生组织（WHO）标准评估治疗反应。使用 Kaplan-Meier 方法确定无进展生存期（PFS）和总生存期（OS）估计值。生存曲线通过对数秩检验进行比较。使用 Cox 比例风险模型进行多变量分析。

结果

整个队列包括 63 名患者。队列的中位年龄为 64 岁。35 名（55.6%）患者为 IV 期。57 名（90.5%）患者进行了淋巴结切除术，45 名（71.4%）患者的淋巴结转移为阳性。53 名（84.1%）患者达到了最大程度的肿瘤减灭术（无残留肿瘤）。然而，6 名（9.5%）患者达到了最佳肿瘤减灭术（残留肿瘤≤1cm），3 名（4.8%）患者达到了次优肿瘤减灭术（残留肿瘤>1cm）。中位随访时间为 19 个月（范围：1-152）。标准辅助治疗后，58 名（92.1%）患者获得完全临床缓解。25 名患者出现疾病复发。研究组的 2 年 PFS 为 51%，2 年 OS 为 80%。多变量分析显示，淋巴结切除术是 PFS 的独立预后因素（优势比：24.794，95%置信区间：4.214-145.869；p<0.001）。