Kadar N, Homesley H D, Malfetano J H
Department of Obstetrics and Gynecology, Jersey Shore Medical Center, Neptune.
Obstet Gynecol. 1994 Dec;84(6):983-6.
To identify prognostic factors in surgical stage III and IV endometrial carcinoma.
We performed a retrospective analysis of 58 cases of stage III and IV endometrial cancer using the Cox proportional hazards model.
Extrapelvic peritoneal metastases and positive peritoneal cytology greatly affected survival. If either of these factors was present, the 2-year survival rate was only 25%, whereas if they were absent, it was 82%. All patients with extrapelvic metastases died of their disease despite systemic therapy, as did ten of 13 patients with positive peritoneal cytology. Although postoperative therapy in these patients varied, it had no obvious effect on survival or on the site of recurrence. In the absence of abdominal disease or positive peritoneal cytology, survival was not influenced significantly by the presence or absence of lymph node metastases. The difference in survival between women with aortic and pelvic lymph node metastases (24% at 5 years) was not significant, but the power to detect this difference was low (35%). Stage affected survival significantly (P < .05), but a two-category variable, indexing patients as having either positive peritoneal cytology or abdominal disease, provided a much better fit and a more parsimonious model for the data.
Five-year survival rates exceeding 70% can be achieved in endometrial carcinoma even if extrauterine disease is present, provided that peritoneal cytology is negative and abdominal metastases are absent.
确定Ⅲ期和Ⅳ期子宫内膜癌的预后因素。
我们采用Cox比例风险模型对58例Ⅲ期和Ⅳ期子宫内膜癌患者进行了回顾性分析。
盆腔外腹膜转移和腹水细胞学阳性对生存率有很大影响。若存在这两个因素中的任何一个，2年生存率仅为25%，而若不存在，则为82%。所有盆腔外转移患者尽管接受了全身治疗，仍死于该病，13例腹水细胞学阳性患者中有10例也是如此。尽管这些患者的术后治疗各不相同，但对生存率或复发部位并无明显影响。在没有腹部病变或腹水细胞学阳性的情况下，淋巴结转移的有无对生存率没有显著影响。主动脉旁和盆腔淋巴结转移女性患者的生存率差异（5年时为24%）并不显著，但检测到这种差异的效能较低（35%）。分期对生存率有显著影响（P < .05），但将患者分为腹水细胞学阳性或有腹部病变两类的变量，对数据的拟合度更好，模型更简洁。
即使存在子宫外病变，只要腹水细胞学阴性且无腹部转移，子宫内膜癌患者5年生存率仍可超过70%。
