Outcomes in surgical stage I uterine papillary serous carcinoma
Outcomes in surgical stage I uterine papillary serous carcinoma
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DOI：
10.1016/j.ygyno.2007.01.041
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发表时间：
2007-06-01
影响因子：
4.7
通讯作者：
Gehrig, Paola A.
中科院分区：
文献类型：
--
作者：
Havrilesky, Laura J.;Secord, Angeles Alvarez;Gehrig, Paola A.
目标。I期子宫乳头状浆液性癌（UPSC）患者的最佳处理尚不清楚。我们试图确定手术期UPSC妇女接受和不接受辅助治疗的结果是否不同。回顾性多机构分析1976年至2006年手术分期的I期UPSC妇女。纳入标准：综合分期包括子宫切除术、双侧输卵管-卵巢切除术、选择性盆腔/主动脉淋巴结切除术、腹膜细胞学检查。采用Kaplan-Meier法分析复发率和生存率。在83名患有I期UPSC的女性中，36名（43%）接受了辅助治疗（23%放疗，3%化疗，15%化疗和放疗，2%黄体酮）。三年总生存率（OS）和无进展生存率（PFS）分别为80%和68%。辅助治疗的3年OS和PFS分别为观察（N = 47） 86%和78%，放疗（N = 17） 63%和44%，化疗加放疗或不加放疗（N = 17） 92%和76%。在18例复发中，9例（50%）包括盆腔外病变。辅助放疗后局部复发率为2/30(7%)，未放疗后局部复发率为7/53 (13%)（p = 0.48）。IB/IC期复发率（15/ 51,29 %）高于IA期（3/ 32,9 %）。22例IA期患者中有1例复发（5%）。在这一系列报道最多的手术期UPSC女性患者中，IB/IC期患者的高复发率（29%）突出了临床试验测试新治疗方法的必要性。手术分期的IA患者预后良好。这些数据提示单纯放疗无效，需要全身治疗，对IA期患者可考虑观察。(c) 2007爱思唯尔公司版权所有。
Objective. The optimal management of patients with stage I uterine papillary serous carcinoma (UPSC) is unclear. We sought to determine whether outcomes of women with surgical stage I UPSC differ with and without adjuvant therapy.Methods. Retrospective multi-institution analysis of women with stage I UPSC surgically staged from 1976 to 2006. Inclusion criteria: comprehensive staging procedure including hysterectomy, bilateral salpingo-oophorectomy, selective pelvic/aortic lymphadenectomy, peritoneal cytology. Recurrence and survival were analyzed using Kaplan-Meier method.Results. Of 83 women with stage I UPSC, 36 (43%) received adjuvant therapies (23% radiotherapy, 3% chemotherapy, 15% chemotherapy and radiotherapy, 2% progestins). Three-year overall (OS) and progression-free survival (PFS) were 80% and 68%, respectively. Three-year OS and PFS by adjuvant treatment were observation (N = 47) 86% and 78%, radiotherapy (N = 17) 63% and 44%, chemotherapy with or without radiotherapy (N = 17) 92% and 76%, respectively. Of the 18 recurrences, 9 (50%) included an extrapelvic component. Local recurrence was 2/30 (7%) following adjuvant radiotherapy and 7/53 (13%) without radiotherapy (p = 0.48). Recurrence was higher in stage IB/IC (15/51, 29%) compared to stage IA (3/32, 9%). There has been one recurrence (5%) among the 22 women observed with stage IA disease.Conclusion. In this largest reported series of women with surgical stage I UPSC, the high recurrence (29%) among patients with stage IB/IC disease highlights the need for clinical trials to test new therapeutic approaches. Surgically staged patients with IA disease had good prognosis. These data suggest that radiotherapy alone is not effective, that systemic therapy is needed, and that observation could be considered in patients with stage IA disease. (c) 2007 Elsevier Inc. All rights reserved.