Bouros D, Papadakis K, Siafakas N, Fuller A F
Department of Thoracic Medicine, Medical School, University of Crete, Heraklion Greece.
Cancer. 1996 Aug 1;78(3):441-7. doi: 10.1002/(SICI)1097-0142(19960801)78:3<441::AID-CNCR10>3.0.CO;2-Z.
Endometrial cancer is the most common female genital cancer and approximately 90% of the cases are diagnosed while they are still confined to the uterus. However, the natural history and treated course after the development of pulmonary metastasis (PM) have not been studied systematically in a large series of patients.
Between 1962 and 1992, 100 patients (6%) with PM were identified by computerized search of the medical records from 1.665 patients admitted to our hospitals with the diagnosis of uterine cancer. The median age of the patients was 65.5 years (range: 42-87 yrs). The usual histologic types of the uterine neoplasms were 59 adenocarcinomas (59%), 21 sarcomas, and 14 adenosquamous carcinomas. Of the 83 patients with reported tumor grade, 11 had Grade 1 tumor, 12 Grade II, and 60 Grade III.
Lung metastases were found at the time of diagnosis of the primary tumor in 22 patients. Hemoptysis was the first symptom of 3 of the 22; the majority had no respiratory symptoms. In the remaining 78 patients with PM appearing after primary therapy, the mean interval time between primary diagnosis and PM was 29.4 months, whereas between PM and death was 15.7 months. Of all patients with lung metastases, 75% did not survive 1 year; however 6% survived more than 5 years after diagnosis of metastatic disease. Patients with isolated PM had prolonged survival (36.1 mos, P=0.001), whether treated medically or with pulmonary resection. Progestin therapy was given to 39 patients, with complete response consisting of radiographic resolution of all disease in 6 patients (15%) and prolonged stabilization in an additional 5 (13%). The histologic grade of the primary tumor was predictive of clinical response to progestine therapy.
Asymptomatic pulmonary metastases represent a common site of extra pelvic spread of disease. The majority of patients with PM (75%) do not survive 1 year. Low grade uterine tumors are more likely to respond to progestin therapy and do so for extended periods of time.
子宫内膜癌是最常见的女性生殖系统癌症，约90%的病例在仍局限于子宫时被诊断出来。然而，尚未对大量患者肺转移（PM）发生后的自然病程和治疗过程进行系统研究。
1962年至1992年间，通过计算机检索我院收治的1665例诊断为子宫癌患者的病历，确定了100例（6%）发生肺转移的患者。患者的中位年龄为65.5岁（范围：42 - 87岁）。子宫肿瘤的常见组织学类型为59例腺癌（59%）、21例肉瘤和14例腺鳞癌。在报告肿瘤分级的83例患者中，11例为1级肿瘤，12例为2级，60例为3级。
22例患者在原发性肿瘤诊断时发现肺转移。咯血是22例中3例的首发症状；大多数患者无呼吸道症状。在其余78例原发性治疗后出现肺转移的患者中，原发性诊断与肺转移之间的平均间隔时间为29.4个月，而肺转移与死亡之间的平均间隔时间为15.7个月。在所有发生肺转移的患者中，75%的患者生存期不足1年；然而，6%的患者在转移性疾病诊断后存活超过5年。孤立性肺转移患者无论接受药物治疗还是肺切除术，生存期均延长（36.1个月，P = 0.001）。39例患者接受了孕激素治疗，6例（15%）患者所有病灶影像学消退且达到完全缓解，另有5例（13%）患者病情长期稳定。原发性肿瘤的组织学分级可预测对孕激素治疗的临床反应。
无症状肺转移是疾病盆腔外扩散的常见部位。大多数肺转移患者（75%）生存期不足1年。低级别子宫肿瘤对孕激素治疗更有可能产生反应，且反应持续时间较长。
