Greven K M, Lanciano R M, Corn B, Case D, Randall M E
Department of Radiology (Radiation Oncology), Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157.
Cancer. 1993 Jun 1;71(11):3697-702. doi: 10.1002/1097-0142(19930601)71:11<3697::aid-cncr2820711137>3.0.co;2-u.
This review was done to assess the outcomes and patterns of recurrence in a group of patients with Stage III endometrial carcinoma that might help guide adjuvant therapy.
A retrospective review was performed of 105 patients treated from 1970-1990 at three institutions. All patients underwent abdominal hysterectomy, with 60 having pathologic node assessment and 45 having cytologic examination of peritoneal washings. A single extrauterine site was involved in 75% of patients; 20% and 5% had two and three sites involved, respectively. All patients received postoperative external beam irradiation to the pelvis or pelvis and paraaortic regions for pathologically positive paraaortic nodes. Actuarial techniques were used to estimate the survival and recurrence rates.
The 5-year disease-free survival rate for all patients was 64%. Univariate analysis revealed that the depth of myometrial penetration, the clear cell or papillary serous pathologic type, the histologic grade, and the number of extrauterine sites predicted disease-free survival. Cox regression revealed the grade and pathologic findings to be independent predictors of disease-free survival. The overall 5-year pelvic recurrence rate was 21%, with multivariate analysis revealing the grade to be the strongest prognostic factor. Pathologic findings and the number of involved extrauterine sites were the most important prognostic factors for abdominal recurrence and other sites of distant relapse.
The subgroup of patients with low-grade endometrial tumors or superficial myometrial penetration has a low distant relapse rate. Local control remains the goal of therapy in these patients. Patients with high-grade tumors, deep myometrial penetration, clear cell or papillary serous histologic types, or two or more involved extrauterine sites are at high risk for distant recurrence that may include the abdomen. Investigative strategies delivering aggressive adjuvant therapy are appropriate.
本综述旨在评估一组III期子宫内膜癌患者的预后及复发模式，以指导辅助治疗。
对1970年至1990年间在三家机构接受治疗的105例患者进行回顾性研究。所有患者均接受了腹式子宫切除术，其中60例进行了病理淋巴结评估，45例进行了腹腔冲洗液细胞学检查。75%的患者有一个子宫外部位受累；20%和5%的患者分别有两个和三个部位受累。所有患者术后均接受盆腔或盆腔及腹主动脉旁区域的体外照射，用于治疗病理检查阳性的腹主动脉旁淋巴结。采用精算技术估计生存率和复发率。
所有患者的5年无病生存率为64%。单因素分析显示，肌层浸润深度、透明细胞或乳头状浆液性病理类型、组织学分级以及子宫外部位数量可预测无病生存。Cox回归显示分级和病理结果是无病生存的独立预测因素。总体5年盆腔复发率为21%，多因素分析显示分级是最强的预后因素。病理结果和受累子宫外部位数量是腹部复发和其他远处复发部位最重要的预后因素。
低级别子宫内膜肿瘤或浅肌层浸润的患者亚组远处复发率较低。局部控制仍是这些患者的治疗目标。高级别肿瘤、深肌层浸润、透明细胞或乳头状浆液性组织学类型或两个或更多子宫外部位受累的患者远处复发风险较高，可能包括腹部。采取积极辅助治疗的研究策略是合适的。
