RELATIONSHIP BETWEEN SURGICAL PATHOLOGICAL RISK-FACTORS AND OUTCOME IN CLINICAL STAGE-I AND STAGE-II CARCINOMA OF THE ENDOMETRIUM - A GYNECOLOGIC ONCOLOGY GROUP-STUDY
RELATIONSHIP BETWEEN SURGICAL PATHOLOGICAL RISK-FACTORS AND OUTCOME IN CLINICAL STAGE-I AND STAGE-II CARCINOMA OF THE ENDOMETRIUM - A GYNECOLOGIC ONCOLOGY GROUP-STUDY
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DOI：
10.1016/0090-8258(91)90086-k
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发表时间：
1991-01-01
影响因子：
4.7
通讯作者：
GRAHAM, JE
中科院分区：
文献类型：
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作者：
MORROW, CP;BUNDY, BN;GRAHAM, JE
1977年6月20日至1983年2月5日，妇科肿瘤组将1180名临床I期或II期（隐匿性）子宫内膜癌妇女纳入了一项病理学分期研究。895例类胶质瘤或腺鳞癌患者可用于本研究，该研究将病理学参数和术后治疗与无复发间隔和复发部位联系起来。对至复发时间进行比例风险建模。对于通过病理学分期确定的无转移的患者，复发的最大决定因素是3级组织学[腺癌3级，相对风险（RR）= 15;腺鳞癌3级，RR = 8.1;所有腺棘皮瘤，RR = 1.0）。在48例组织学证实有主动脉淋巴结转移的患者中，47例具有以下一种或多种特征：（1）盆腔淋巴结大体阳性，（2）附件转移大体阳性，或（3）外三分之一肌层浸润。48.0%的患者接受盆腔放射治疗，10.2%的患者接受阴道近距离放射治疗; 41.8%的患者未接受辅助放射治疗。阴道植入组的3例复发中无一例为阴道或盆腔复发;盆腔放疗（RT）组7.4%（7/95）的复发为阴道复发，16.8%为盆腔复发;无辅助放疗组18.2%（8/44）的复发为阴道复发，31.8%为盆腔复发。由于高度的选择偏倚，无法对这些组中的无复发间期进行有效比较。阴性病理学危险因素（除分级和肌层浸润外）患者的5年无复发间隔为92.7%;峡部/宫颈受累69.8%;盆腔细胞学阳性56.0%;血管间隙浸润55.0%;盆腔淋巴结或附件转移57.8%;主动脉淋巴结转移或大体剖腹探查结果41.2%。目前尚不清楚宫颈浸润本身是否会降低生存率，因为与无宫颈浸润的病例相比，宫颈浸润更常与肿瘤分化差（34.7% vs 24.0%，3级）和深部肌层浸润（47.0% vs 18.6%）相关。宫颈癌阳性和阴性的3级病变和深部肌层浸润病例的复发率无显著差异（48.8%比39.8%）。阴道/盆腔失败的比例（仅手术组为34.6%，RT组为12.5%）似乎有利于对超过三分之一肌浸润和2级或3级肿瘤的患者使用辅助放疗。研究组中有97例恶性细胞学检查患者，其中29.1%的患者局部/远端失败，而细胞学阴性患者为10.5%。这些数据似乎表明恶性细胞学检查是一种严重的不良结果，尤其是在区域/远端和腹部衰竭的风险方面。
Between June 20, 1977 and February 5, 1983, the Gynecologic Oncology Group entered 1180 women with clinical stage I or II (occult) endometrial carcinoma into a surgical-pathological staging study. Eight hundred ninety-five patients with endometrioid or adenosquamous carcinoma were evaluable for this study which relates surgical-pathological parameters and postoperative treatment to recurrence-free interval and recurrence site. Proportional hazards modeling of time to recurrence was performed. For patients without metastasis determined by surgical-pathological staging the greatest determinant of recurrence was grade 3 histology [adenocarcinoma grade 3, relative risk (RR) = 15; adenosquamous carcinoma grade 3, RR = 8.1; all adenocanthomas, RR = 1.0). Of 48 patients with histologically documented aortic node metastases, 47 had one or more of the following features: (1) grossly positive pelvic nodes, (2) grossly positive adnexal metastasis, or (3) outer one-third myometrial invasion. Pelvic radiation was administered to 48.0% and vaginal brachytherapy alone to 10.2% of patients postoperatively; 41.8% received no adjuvant radiation therapy. None of three recurrences in the vaginal implant group were vaginal or pelvic; 7.4% (7 of 95) of recurrences in the pelvic radiation therapy (RT) group were vaginal and 16.8% were pelvic; 18.2% (8 of 44) of recurrences in the no adjuvant radiation group were vaginal and 31.8% pelvic. Because of the high degree of selection bias no valid comparisons can be made of recurrence-free interval in these groups. The 5-year recurrence-free interval for patients with negative surgical-pathological risk factors (other than grade and myoinvasion) was 92.7%; involvement of the isthmus/cervix 69.8%; positive pelvic cytology 56.0%; vascular space invasion 55.0%; pelvic node or adnexal metastases 57.8%; and aortic node metastases or gross laparotomy findings 41.2%. It is not clear that cervix invasion per se diminishes survival, because it is more often associated with poor tumor differentiation (34.7% versus 24.0%, grade 3) and deep myoinvasion (47.0% vs 18.6%) than cases without cervix invasion. The relapse rate among cervix-positive and -negative cases with grade 3 lesions and deep myoinvasion is not dramatically different (48.8% vs 39.8%). The proportion of failures which were vaginal/pelvic (34.6% for the surgery only group compared to 12.5% of the RT group) appears to favor the use of adjuvant radiation for patients with more than one-third myoinvasion and grade 2 or 3 tumor. There were 97 patients in the study group with malignant cytology of which 29.1% had regional/distant failure, which compares to 10.5% of the cytology-negative patients. These data seem to implicate malignant cytology as a serious adverse finding, especially with respect to the risk for regional/distant and abdominal failure.