Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, The University of British Columbia and BC Cancer, Vancouver, British Columbia, Canada
Department of Women's Health, Tübingen University Hospital, Tübingen, Germany.
Int J Gynecol Cancer. 2024 Apr 1;34(4):544-549. doi: 10.1136/ijgc-2023-005149.
Optimal management of patients with stage IA p53abn endometrial cancer without myoinvasion, classified as intermediate risk in the 2020 European Society of Gynaecological Oncology, European Society for Radiotherapy and Oncology, and European Society of Pathology (ESGO-ESTRO-ESP) guidelines, and the 2022 European Society of Medical Oncology (ESMO) guidelines, is currently unclear. Practice varies from surgery alone to adjuvant radiation±chemotherapy. Our aim was to assess the risk of disease recurrence in patients with stage IA p53abn endometrial cancer without myoinvasion compared with stage IA with myoinvasion (<50%).
Stage IA p53abn endometrial cancers were identified from retrospective cohorts. Cases were segregated into stage IA with no myoinvasion, including (1) tumor restricted to a polyp, (2) residual endometrial tumor, and (3) no residual tumor in hysterectomy specimen, versus stage IA p53abn with myoinvasion (<50%), with treatment and outcomes assessed.
There were 65 stage IA p53abn endometrial cancers with no myoinvasion (22 polyp confined, 38 residual endometrial tumor, 2 no residual in hysterectomy specimen, 3 not specified) and 97 with myoinvasion. There was no difference in survival outcomes in patients with stage IA without myoinvasion (16% of patients recurred, 19% if there was residual endometrial disease) compared with stage IA with myoinvasion (17%). The risk of recurrence was lowest in patients with stage IA p53abn endometrial cancer without myoinvasion treated with chemotherapy±radiation (8%). Most recurrences in patients with stage IA without myoinvasion were distant (89%), with no isolated vaginal vault recurrences, and all except one distant recurrence occurred in patients who had not received adjuvant chemotherapy.
The recurrence rate in patients with stage IA p53abn endometrial cancer without myoinvasion was 16%, highest in the setting of residual endometrial disease (19%), and exceeding the threshold where adjuvant therapy is often considered. The high frequency of distant recurrences observed may support chemotherapy as part of the treatment regimen.
在 2020 年欧洲妇科肿瘤学会（ESGO）、欧洲放射肿瘤学会（ESTRO）和欧洲病理学会（ESP）指南以及 2022 年欧洲肿瘤内科学会（ESMO）指南中，对于没有肌层浸润的 p53abnIA 期子宫内膜癌（被归类为中危）的最佳管理目前尚不清楚。实践中，治疗方法从单纯手术到辅助放疗加化疗不等。我们的目的是评估与 p53abnIA 期有肌层浸润（<50%）的子宫内膜癌患者相比，无肌层浸润的 p53abnIA 期子宫内膜癌患者的疾病复发风险。
从回顾性队列中确定 p53abnIA 期子宫内膜癌病例。将病例分为无肌层浸润的 p53abnIA 期，包括（1）肿瘤局限于息肉，（2）残留子宫内膜肿瘤，（3）子宫切除标本中无残留肿瘤，与 p53abnIA 期有肌层浸润（<50%）进行比较，评估治疗和结局。
共有 65 例无肌层浸润的 p53abnIA 期子宫内膜癌（22 例局限于息肉，38 例残留子宫内膜肿瘤，2 例子宫切除标本中无残留肿瘤，3 例未具体说明）和 97 例有肌层浸润的病例。无肌层浸润的 p53abnIA 期患者（16%的患者复发，残留子宫内膜疾病患者为 19%）与有肌层浸润的 p53abnIA 期患者（17%）的生存结局无差异。无肌层浸润且接受化疗加放疗的 p53abnIA 期子宫内膜癌患者的复发风险最低（8%）。无肌层浸润的 p53abnIA 期患者的大多数复发为远处转移（89%），无阴道穹窿孤立复发，除 1 例外，所有远处复发均发生在未接受辅助化疗的患者中。
无肌层浸润的 p53abnIA 期子宫内膜癌患者的复发率为 16%，在残留子宫内膜疾病的情况下最高（19%），超过了通常考虑辅助治疗的阈值。观察到的远处复发频率较高可能支持将化疗作为治疗方案的一部分。
