Leminen A, Forss M, Lehtovirta P
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland.
Acta Obstet Gynecol Scand. 1995 Jan;74(1):61-6. doi: 10.3109/00016349509009946.
The accuracy of clinical staging is known to be insufficient in stage II endometrial carcinoma. Also the optimal management of this disease is controversial. In this study we evaluate diagnostic accuracy and prognostic factors with special reference to treatment modalities of stage II endometrial carcinoma.
Of 1297 patients with endometrial adenocarcinoma (EAC) treated between 1970 and 1980 at Departments of Obstetrics and Gynecology, Helsinki University Central Hospital, 140 (11%) cases represented clinical stage II and were retrospectively analyzed.
Median age of the patients was 63.5 years (range 40-85 years). Accuracy of Papanicolaou smear was 50%, and that of endocervical curettage 51%. Most of the tumors were histopathologically pure adenocarcinomas (88%), well differentiated (43%), and superficially invaded to myometrium (44%). Thirty-four (24%) of the patients developed a recurrent disease during the first five years afterwards. Median time of recurrency was 17 months (range 4-35 months). The disease free 5- or 10-year survival were 72% and 67%. Survival was significantly correlated with menopausal state (p < 0.01), tumor grade (p < 0.05), myometrial invasion (p < 0.001), surgical stage (p < 0.0001), and mode of treatment, i.e. operation done or not (p < 0.05). Survival was not affected by the radical nature of the operation (radical vs. simple hysterectomy). When all prognostic variables were analyzed by Cox's regression model (multivariate analysis) in 10-years follow-up, only menopausal state, myometrial invasion, and mode of treatment, i.e. operation done or not (p < 0.01), were independent prognostic factors.
The only relevant staging procedure is the histological examination of cervix without the preoperative irradiation. According to our results it seems that simple hysterectomy instead of radical (Wertheim operation) hysterectomy may be a sufficient operative treatment of stage II endometrial carcinoma.
已知临床分期在II期子宫内膜癌中的准确性不足。而且该疾病的最佳治疗方案也存在争议。在本研究中，我们评估了诊断准确性和预后因素，并特别参考了II期子宫内膜癌的治疗方式。
在1970年至1980年间于赫尔辛基大学中心医院妇产科接受治疗的1297例子宫内膜腺癌（EAC）患者中，140例（11%）为临床II期病例，并进行了回顾性分析。
患者的中位年龄为63.5岁（范围40 - 85岁）。巴氏涂片的准确率为50%，宫颈刮除术的准确率为51%。大多数肿瘤在组织病理学上为单纯腺癌（88%），高分化（43%），且浅肌层浸润（44%）。34例（24%）患者在随后的五年内出现复发疾病。复发的中位时间为17个月（范围4 - 35个月）。5年和10年无病生存率分别为72%和67%。生存率与绝经状态（p < 0.01）、肿瘤分级（p < 0.05）、肌层浸润（p < 0.001）、手术分期（p < 0.0001）以及治疗方式，即是否进行手术（p < 0.05）显著相关。生存率不受手术根治性（根治性子宫切除术与单纯子宫切除术）的影响。在10年随访中，当通过Cox回归模型（多变量分析）分析所有预后变量时，只有绝经状态、肌层浸润以及治疗方式，即是否进行手术（p < 0.01）是独立的预后因素。
唯一相关的分期程序是在不进行术前放疗的情况下对宫颈进行组织学检查。根据我们的结果，对于II期子宫内膜癌，单纯子宫切除术而非根治性（韦特海姆手术）子宫切除术似乎可能是一种足够的手术治疗方法。
