Gerszten K, Faul C, Kounelis S, Huang Q, Kelley J, Jones M W
Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Gynecol Oncol. 1998 Jan;68(1):8-13. doi: 10.1006/gyno.1997.4901.
The role of adjuvant radiotherapy in the setting of uterine carcinosarcoma has not been clearly established.
A retrospective review of 60 patients receiving definitive therapy for carcinosarcoma of the uterus was undertaken at a single institution. Twenty-nine of 60 patients were treated with adjuvant radiotherapy.
The addition of radiotherapy significantly reduced the local recurrence rate from 55% (17 patients) to 3% (1 patient). Adjuvant radiotherapy reduced the risk of distant failure and death in patients with disease confined to the uterus but did not impact distant recurrence or survival in stage III patients. Increasing stage and depth of myometrial tumor invasion were negatively associated with overall survival and disease-free survival but had no impact on local recurrence rates. The nuclear grade of the epithelial component was predictive of local recurrence (P = 0.0592), but epithelial architectural grade, grade of stromal component, and stromal versus epithelial predominance did not provide prognostic information. The relative risk of local recurrence of unirradiated patients versus irradiated patients was 17.54 (P = 0.0055) after adjusting for nuclear grade of the epithelial component.
Local failure represents a significant site of failure in the absence of adjuvant radiotherapy. The improvement in local failure rates with the addition of radiotherapy translates into an improvement in distant failure rates and survival only for patients with stage I/II disease. Epithelial nuclear grade, in addition to depth of myometrial invasion and stage, provides important prognostic information. Epithelial architectural grade, stromal grade, type of stromal component (homologous versus heterologous), and predominance of either stromal or epithelial component were not found to be significant prognostic factors.
辅助放疗在子宫癌肉瘤治疗中的作用尚未明确确立。
在单一机构对60例接受子宫癌肉瘤确定性治疗的患者进行回顾性研究。60例患者中有29例接受了辅助放疗。
放疗的加入显著降低了局部复发率，从55%（17例患者）降至3%（1例患者）。辅助放疗降低了局限于子宫的疾病患者远处失败和死亡的风险，但对III期患者的远处复发或生存没有影响。肌层肿瘤浸润分期增加和深度与总生存期和无病生存期呈负相关，但对局部复发率没有影响。上皮成分的核分级可预测局部复发（P = 0.0592），但上皮结构分级、间质成分分级以及间质与上皮的优势程度未提供预后信息。在调整上皮成分核分级后，未接受放疗患者与接受放疗患者的局部复发相对风险为17.54（P = 0.0055）。
在没有辅助放疗的情况下，局部失败是一个重要的失败部位。放疗的加入改善了局部失败率，仅对I/II期疾病患者的远处失败率和生存率有改善作用。除了肌层浸润深度和分期外，上皮核分级提供了重要的预后信息。上皮结构分级、间质分级、间质成分类型（同源与异源）以及间质或上皮成分的优势程度未被发现是显著的预后因素。
