Hong Ji Hyun, Kang Jun, Lee Sung Jong, Lee Keun Ho, Hur Soo Young, Kim Yeon-Sil
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Cancers (Basel). 2025 Jun 19;17(12):2056. doi: 10.3390/cancers17122056.
High-grade endometrial cancer, including non-endometrioid and grade 3 endometrioid histologies, is associated with poor prognosis despite early-stage diagnosis. This study assessed the prognosis of early-stage high-grade endometrial cancer, identified prognostic factors, and evaluated the optimal candidates for adjuvant therapy. We retrospectively analyzed 106 patients with 2018 FIGO stage I-II high-grade endometrial cancer who underwent hysterectomies between 2008 and 2022. Adjuvant therapy was determined by a multidisciplinary team. Survival outcomes were evaluated using the Kaplan-Meier method and Cox regression model. Of 106 patients, 60 had non-endometrioid, and 46 had grade 3 endometrioid carcinoma; 69 (65.1%) received adjuvant therapy. After a median follow-up of 48.8 months, 37 patients experienced disease progression, and 21 died. Non-endometrioid histology was significantly associated with worse overall survival ( = 0.002). Lack of lymph node dissection, deeper invasion, and the omission of adjuvant therapy were additional adverse prognostic factors. Adjuvant therapy improved the overall survival ( = 0.009), disease-free survival ( = 0.021), and locoregional recurrence-free survival ( = 0.034) in patients with one or two risk factors. Non-endometrioid histology, deep invasion, and the lack of lymph node dissection are associated with worse survival in early-stage high-grade endometrial cancer. Adjuvant therapy should be considered in patients with these risk factors.
高级别子宫内膜癌，包括非子宫内膜样癌和3级子宫内膜样癌组织学类型，尽管早期诊断，但预后较差。本研究评估了早期高级别子宫内膜癌的预后，确定了预后因素，并评估了辅助治疗的最佳候选者。我们回顾性分析了2008年至2022年间接受子宫切除术的106例2018年FIGO I-II期高级别子宫内膜癌患者。辅助治疗由多学科团队确定。使用Kaplan-Meier法和Cox回归模型评估生存结局。106例患者中，60例为非子宫内膜样癌，46例为3级子宫内膜样癌；69例（65.1%）接受了辅助治疗。中位随访48.8个月后，37例患者出现疾病进展，21例死亡。非子宫内膜样组织学与较差的总生存期显著相关（P = 0.002）。未进行淋巴结清扫、侵犯更深以及未进行辅助治疗是额外的不良预后因素。辅助治疗改善了有一个或两个危险因素患者的总生存期（P = 0.009）、无病生存期（P = 0.021）和局部区域无复发生存期（P = 0.034）。非子宫内膜样组织学、侵犯更深和未进行淋巴结清扫与早期高级别子宫内膜癌较差的生存率相关。有这些危险因素的患者应考虑辅助治疗。
