Kauppila A, Grönroos M, Nieminen U
Obstet Gynecol. 1982 Oct;60(4):473-80.
Patients with endometrial carcinoma (N = 1113) were treated by conventional therapy, using surgery and radiotherapy, complemented by daily administration of 100 mg oral medroxyprogesterone acetate (MPA) for a 2-year period. Only 7.3% of the malignancies were at an advanced clinical stage (III or IV), whereas 75.9 and 16.8% of the carcinomas were detected at clinical stages I and II, respectively. The 5-year survival rate was 71.0% overall, and 77.8%, 61.0, 29.0, and 5.3 for clinical stages I, II, III, and IV, respectively. Patients with anaplastic carcinoma (grade 3) at all clinical stages had significantly lower survival rates than had patients with well-differentiated (grade 1) and moderately differentiated (grade 2) adenocarcinomas. Death of grade 1, grade 2 and grade 3 endometrial carcinoma during the first 2 years occurred in 4.7, 6.8, and 18.2% of cases, respectively, in stage II, indicating that adjuvant MPA cannot totally prevent the progression of endometrial malignancy. The incidence of anaplastic endometrial carcinoma increased with the spread of the disease. It often appeared in patients with low body weight or a second invasive malignancy, but seldom occurred in young patients or patients with diabetes, uterine myoma, or a history of previous estrogen use. The worsened prognosis associated with old age, low body weight, and presence of a second invasive malignancy thus seems at lest partly due to the increased incidence of anaplastic carcinoma, which, on the other hand, did not contribute to the decreased 5-year survival rate of patients with diabetes or severe hypertension.
子宫内膜癌患者（N = 1113）接受了常规治疗，采用手术和放疗，并辅以每日口服100毫克醋酸甲羟孕酮（MPA），为期2年。只有7.3%的恶性肿瘤处于临床晚期（III期或IV期），而分别有75.9%和16.8%的癌症在临床I期和II期被检测到。总体5年生存率为71.0%，临床I期、II期、III期和IV期分别为77.8%、61.0%、29.0%和5.3%。所有临床分期的间变癌（3级）患者的生存率明显低于高分化（1级）和中分化（2级）腺癌患者。II期患者中，1级、2级和3级子宫内膜癌在头2年的死亡率分别为4.7%、6.8%和18.2%，这表明辅助性MPA不能完全阻止子宫内膜恶性肿瘤的进展。间变性子宫内膜癌的发病率随疾病的扩散而增加。它常出现在体重低或患有第二种侵袭性恶性肿瘤的患者中，但很少发生在年轻患者或患有糖尿病、子宫肌瘤或有既往雌激素使用史的患者中。因此，与老年、低体重和存在第二种侵袭性恶性肿瘤相关的预后恶化似乎至少部分归因于间变癌发病率的增加，而另一方面，间变癌并未导致糖尿病或重度高血压患者5年生存率的降低。
