Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Eur J Obstet Gynecol Reprod Biol. 2024 Oct;301:154-159. doi: 10.1016/j.ejogrb.2024.08.014. Epub 2024 Aug 12.
Females with low-risk endometrial cancer typically have low lymph node metastasis risk and promising prognosis without lymphadenectomy. However, the impact of grade 3 endometrial cancer on nodal involvement, recurrence, and prognosis within this specific subgroup remains unclear. Therefore, in this study, we aimed to investigate the prognosis, patterns of metastasis, and recurrence in a subgroup of females with grade 3 early-stage low-risk endometrioid endometrial cancer.
We identified patients from the endometrial cancer cohorts of seven institutional hospitals. The study included patients who underwent hysterectomy between January 2013 and December 2021 with preoperative endometrioid histological type, less than half myometrial invasion, no tumor spread outside the corpus on imaging, normal CA-125 level, and histological grade 3. The clinicopathological characteristics and survival outcomes of the patients were collected. Recurrence-free survival was estimated using the Kaplan-Meier method and compared using the log rank test.
Overall, 36 patients were included in this analysis. Of the 33 patients who underwent lymphadenectomy, 1 (1/33, 3.0 %) had lymph node metastasis and 27 (75.0 %) received adjuvant therapy. At a median follow-up of 58 months, three females (8 %) had recurrence and all cases involved lymph nodes. The 5-year recurrence-free survival was 88.7 %. No significant difference was observed in the recurrence-free survival between females who did and did not undergo lymphadenectomy (p = 0.554).
Females diagnosed with low-risk grade 3 endometrial cancer typically have favorable prognosis. However, lymph node metastasis and recurrence risks still exist, with all recorded instances of recurrence involving lymph nodes.
患有低危子宫内膜癌的女性通常具有较低的淋巴结转移风险和良好的预后，无需进行淋巴结切除术。然而，在这一特定亚组中，子宫内膜癌 3 级对淋巴结受累、复发和预后的影响尚不清楚。因此，本研究旨在探讨亚组中具有低危子宫内膜样型 3 级早期子宫内膜癌的女性的预后、转移模式和复发情况。
我们从 7 家机构医院的子宫内膜癌队列中确定了患者。该研究纳入了 2013 年 1 月至 2021 年 12 月期间接受子宫切除术且术前为子宫内膜组织学类型、肌层浸润小于一半、影像学上无肿瘤扩散至子宫体以外、CA-125 水平正常、组织学分级为 3 级的患者。收集了患者的临床病理特征和生存结局。采用 Kaplan-Meier 法估计无复发生存率，并采用对数秩检验进行比较。
总体而言，本研究共纳入 36 例患者。在 33 例行淋巴结切除术的患者中，有 1 例（1/33，3.0%）发生淋巴结转移，27 例（75.0%）接受了辅助治疗。中位随访时间为 58 个月，有 3 例女性（8%）复发，所有病例均累及淋巴结。5 年无复发生存率为 88.7%。是否行淋巴结切除术的女性之间，无复发生存率无显著差异（p=0.554）。
诊断为低危 3 级子宫内膜癌的女性通常具有良好的预后。然而，仍存在淋巴结转移和复发风险，所有记录的复发病例均累及淋巴结。
