Boente M P, Orandi Y A, Yordan E L, Miller A, Graham J E, Kirshner C, Wilbanks G D
Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Ann Surg Oncol. 1995 Mar;2(2):138-44. doi: 10.1007/BF02303629.
Cervical involvement in endometrial carcinoma is a diverse entity, and the optimal management of these patients is not well understood.
Recurrence patterns and complications in 202 patients with histologically confirmed endometrial carcinoma with cervical involvement were retrospectively studied.
The 5-year actuarial survival rate for all patients was 65%. Recurrences were documented in 80 (40%) of the patients, and the overall long-term survival rate in this group was 4%. Patients treated with radical hysterectomy (n = 33) had a 6% isolated pelvic recurrence rate and the lowest serious complication rate among the five treatment groups despite having the highest frequency of risk factors for recurrence among any of the groups studied. Patients treated with extrafascial hysterectomy alone (n = 37) had a 14% pelvic recurrence rate and very few complications. When radiotherapy preceded extrafascial hysterectomy (n = 37), the frequency of pelvic recurrences was 30%, and 19% experienced serious gastrointestinal or genitourinary tract complications. When radiotherapy followed extrafascial hysterectomy (n = 68), the pelvic recurrence rate was 24%, and 13% experienced serious complications. Overall, 24% of patients (49 of 202) had isolated pelvic recurrences, whereas 10% (21 of 202) had isolated distant recurrences and 5% (10 of 202) were simultaneously diagnosed with both pelvic and distant recurrences.
This large data base suggests that older conventional forms of therapy, particularly those using preoperative radiotherapy, subject the patient to significant morbidity over a 5- to 10-year period and, in terms of local control, are not necessarily superior to therapeutic modalities using primary surgical evaluation, such as radical hysterectomy. Consideration of primary surgery should be given in the appropriate situation, and radical hysterectomy should be considered when gross cervical involvement is encountered and intraoperative exploration does not show obvious extrauterine disease.
子宫内膜癌累及宫颈是一种复杂的情况，目前对这类患者的最佳治疗方案尚不清楚。
对202例经组织学确诊为子宫内膜癌累及宫颈的患者的复发模式和并发症进行回顾性研究。
所有患者的5年精算生存率为65%。80例（40%）患者出现复发，该组的总体长期生存率为4%。接受根治性子宫切除术的患者（n = 33）孤立盆腔复发率为6%，在五个治疗组中严重并发症发生率最低，尽管在所有研究组中其复发风险因素出现频率最高。仅接受筋膜外子宫切除术的患者（n = 37）盆腔复发率为14%，并发症很少。在筋膜外子宫切除术前行放射治疗的患者（n = 37），盆腔复发频率为30%，19%出现严重的胃肠道或泌尿生殖道并发症。在筋膜外子宫切除术后行放射治疗的患者（n = 68），盆腔复发率为24%，13%出现严重并发症。总体而言，24%的患者（202例中的49例）有孤立盆腔复发，而10%（202例中的21例）有孤立远处复发，5%（202例中的10例）同时被诊断为盆腔和远处复发。
这个大型数据库表明，传统的较老治疗方式，特别是那些使用术前放疗的方式，会使患者在5至10年期间出现明显的发病率，并且就局部控制而言，不一定优于使用初次手术评估的治疗方式，如根治性子宫切除术。在适当情况下应考虑初次手术，当遇到宫颈明显受累且术中探查未发现明显子宫外疾病时，应考虑根治性子宫切除术。
