Behbakht K, Yordan E L, Casey C, DeGeest K, Massad L S, Kirschner C V, Wilbanks G D
Section of Gynecologic Oncology, Rush Medical College, Chicago, Illinois 60612.
Gynecol Oncol. 1994 Dec;55(3 Pt 1):363-7. doi: 10.1006/gyno.1994.1307.
Advanced endometrial cancer represents 14% of all stages but 54% of all deaths attributed to endometrial cancer. From 1973 to 1990, the charts of 137 patients with endometrial cancer (Stage III and IV) treated by the section of Gynecologic Oncology at Rush Medical College were retrospectively reviewed. The log rank method was used for univariate analysis and Cox proportional hazards regression was used for multivariate analysis. The patients were stratified as follows: Stage III, 92 (67.2%), Stage IV, 45 (32.8%); Grade 1, 15 (10.9%), Grade 2, 47 (34.3%), Grade 3, 67 (48.9%); adenocarcinoma, 93 (67.9%), adenosquamous, 18 (13.1%), adenoacanthoma, 2 (1.5%), clear cell, 1 (0.7%), papillary serous, 23 (16.8%). Using univariate analysis, median survival was 1.71 years for Stage III versus 0.68 years for Stage IV. Median survival based on treatment was as follows: radiotherapy (RT) only (n = 16), 0.89 years, surgery only (n = 36), 0.75 years, preoperative RT+surgery (n = 7), 2.5 years, surgery+postoperative RT (n = 56), 2.63 years, and other treatments (hormonal only n = 12, chemotherapy only n = 1, and no treatment n = 9), 0.6 years. Patients with vaginal extension survived a median of 0.82 years, versus 2.49 years without this factor (P = 0.002). Patients with clinically apparent parametrial involvement survived a median of 0.70 years versus 2.65 years without this factor (P = 0.0003). Multivariate analysis was possible via a surgical database (n = 99). Age > 60 (P = 0.01), parametrial involvement (P = 0.04), and abdominal metastases (P = 0.003) were significant prognostic indicators. Papillary or clear cell histology, advanced grade, and mode of treatment were not significant. Patients with abdominal metastases or parametrial extension of tumor have a significant decrease in mean survival.
晚期子宫内膜癌占所有分期的14%，但在子宫内膜癌所致的所有死亡病例中占54%。回顾性分析了1973年至1990年在拉什医学院妇科肿瘤科室接受治疗的137例子宫内膜癌（Ⅲ期和Ⅳ期）患者的病历。采用对数秩检验进行单因素分析，采用Cox比例风险回归进行多因素分析。患者分层如下：Ⅲ期92例（67.2%），Ⅳ期45例（32.8%）；1级15例（10.9%），2级47例（34.3%），3级67例（48.9%）；腺癌93例（67.9%），腺鳞癌18例（13.1%），腺棘皮癌2例（1.5%），透明细胞癌1例（0.7%），乳头状浆液性癌23例（16.8%）。单因素分析显示，Ⅲ期患者的中位生存期为1.71年，Ⅳ期为0.68年。基于治疗方式的中位生存期如下：单纯放疗（RT）（n = 16），0.89年；单纯手术（n = 36），0.75年；术前放疗+手术（n = 7），2.5年；手术+术后放疗（n = 56），2.63年；其他治疗（单纯激素治疗n = 12，单纯化疗n = 1，未治疗n = 9），0.6年。有阴道转移的患者中位生存期为0.82年，无此因素者为2.49年（P = 0.002）。有临床明显宫旁组织受累的患者中位生存期为0.70年，无此因素者为2.65年（P = 0.0003）。通过手术数据库（n = 99）进行多因素分析。年龄>60岁（P = 0.01）、宫旁组织受累（P = 0.04）和腹部转移（P = 0.003）是显著的预后指标。乳头状或透明细胞组织学类型、高分级和治疗方式无显著意义。有腹部转移或肿瘤宫旁组织扩展的患者平均生存期显著缩短。
