Han Zhihong, Zheng Zhong, Tao Kai, Yu Yanping, Wu Jinping, Tian Xiaofei
Department of Gynecologic Oncology, Shaanxi Provincial Tumor Hospital, Xi'an, China.
Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Gland Surg. 2021 Jan;10(1):355-363. doi: 10.21037/gs-20-887.
High-risk histologic endometrioid carcinomas include poorly differentiated endometrial carcinoma (PDEC), uterine clear cell carcinoma (UCCC), uterine carcinosarcoma (UCS), and uterine papillary serous carcinomas (UPCS). The purpose of this study was to investigate and compare the effect of open surgery and minimally invasive surgery on the prognosis of patients with high-risk endometrial cancer tissue types.
A retrospective analysis was conducted to investigate 57 UCS or UPCS, 53 UCCC, and 110 PDEC patients receiving initial treatment at the Department of Gynecology in Shaanxi Provincial Tumor hospital and the Affiliated Hospital of Medical College of Xi'an Jiaotong University between February 2010 and January 2015. Prognostic factors were determined using univariate/multivariate analysis, and survival rates were assessed using the Kaplan-Meier method. The Cox regression model was adopted to assess the independent prognostic factors.
Two hundred and twenty patients who met the criteria were included in this study. At the end of follow-up period, 94 patients were still alive. Univariate analysis found that the survival time of the patients was related to staging, adjuvant therapy, and surgical approach. Multivariate analysis revealed that surgical approach, staging, pathology, and adjuvant therapy were independent prognostic factors.
Minimally invasive surgery has a shorter survival time compared to open surgery in women with PDEC, UCCC, UCS, and UPCS. Multivariate analysis confirmed that staging, pathological type, surgical approach, and postoperative adjuvant therapy are independent risk factors for prognosis and affect the survival of women with PDEC, UCCC, UCS, and UPCS.
高危组织学类型的子宫内膜样癌包括低分化子宫内膜癌（PDEC）、子宫透明细胞癌（UCCC）、子宫癌肉瘤（UCS）和子宫浆液性乳头状癌（UPCS）。本研究的目的是调查和比较开放手术与微创手术对高危子宫内膜癌组织类型患者预后的影响。
对2010年2月至2015年1月期间在陕西省肿瘤医院妇科和西安交通大学医学院附属医院接受初始治疗的57例UCS或UPCS、53例UCCC和110例PDEC患者进行回顾性分析。采用单因素/多因素分析确定预后因素，采用Kaplan-Meier法评估生存率。采用Cox回归模型评估独立预后因素。
本研究纳入了220例符合标准的患者。随访期末，94例患者仍存活。单因素分析发现患者的生存时间与分期、辅助治疗和手术方式有关。多因素分析显示手术方式、分期、病理和辅助治疗是独立的预后因素。
对于PDEC、UCCC、UCS和UPCS患者，微创手术的生存时间比开放手术短。多因素分析证实分期、病理类型、手术方式和术后辅助治疗是预后的独立危险因素，并影响PDEC、UCCC、UCS和UPCS患者的生存。
