Is there a difference in outcome between stage I-II endometrial cancer of papillary serous/clear cell and endometrioid FIGO Grade 3 cancer?
Is there a difference in outcome between stage I-II endometrial cancer of papillary serous/clear cell and endometrioid FIGO Grade 3 cancer?
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DOI：
10.1016/s0360-3016(02)02913-9
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发表时间：
2002-09-01
影响因子：
7
通讯作者：
Barakat, RR
中科院分区：
文献类型：
--
作者：
Alektiar, KM;McKee, A;Barakat, RR
目的：文献中的一些报道表明，与类乳头状腺癌相比，乳头状浆液性（PS）和透明细胞（CC）组织学特征的患者表现更差。然而，目前尚不清楚PS/CC癌症的结果是否与低分化类胶质瘤不同。本研究的目的是比较PS/CC和子宫内膜样癌国际妇产科联合会（FIGO）3级癌症之间的结果，并且仅限于I-II期子宫癌患者。在1987年11月至1999年9月期间，83例I期子宫内膜癌和II期隐匿性子宫内膜癌患者接受了单纯子宫切除术和高剂量率阴道内近距离放射治疗。41名患者（49%）患有FIGO 3级类胶质瘤（第1组），42名患者（51%）具有PS/CC组织学特征（第2组）。平均年龄为63岁（范围30-89岁）。83例患者中有23例（28%）进行了综合手术分期。83例患者中有24例（29%）出现毛细血管间隙样浸润（CSLI）。阴道内近距离放射治疗的中位剂量为21戈伊，分3次进行。83例患者中42例（51%）接受了45戈伊的外照射。两组在年龄、种族、综合手术分期、子宫肌层受累量、CSLI、子宫下段受累、宫颈受累和外照射放疗的使用方面平衡。中位随访时间为46个月（范围4-147）。结果：复发模式如下：14例患者中5例为阴道/骨盆，15例患者中8例为肺部，12例患者中4例为腹腔内，14例患者中1例为锁骨上淋巴结。4例腹腔内播散中的1例发生在第I组，其他3例发生在第2组（p = 0.6）。5年阴道盆腔控制率、无病生存率（DFS）和总生存率（OS）分别为93%（95%置信区间[CI] 87-99%）、79%（95% CI 69-89%）和74%（95% CI 64-85%）。第1组和第2组之间的结局无显著差异。第1组的5年阴道/盆腔控制率为97%（95% CI 91-100%），第2组为90%（95% CI 81-99%）（p = 0.2）。第1组的5年DFS率为79%（95% CI 64-95%），第2组为78%（95% CI 65-92%）（p = 0.6），第1组的5年OS率为71%（95% CI 55-87%），第2组为79%（95% CI 66-92%）（p = 0.3）。评估了年龄、种族、综合手术分期、CSLI、子宫肌层浸润量、宫颈受累、子宫下段受累以及单纯PS或CC组织学特征对结局的影响。在多变量分析中，只有CSLI与较差的DFS相关（P 0.04;相对风险3，95% CI 1-9）和OS（p = 0.02;相对风险3，95% CI 1-6）。根据本研究的结果，具有PS/CC组织学特征的I-II期子宫内膜癌患者与具有相似分期疾病的患者之间的结局不存在显著差异，但具有FIGO 3级类肉瘤组织学特征。CSLI是不良DFS和OS的唯一独立预测因子。（C）2002 Elsevier Science Inc.
Purpose: Several reports in the literature have shown that, compared with endometrioid adenocarcinoma, patients with papillary serous (PS) and clear cell (CC) histologic features do worse. However, it is unclear whether the outcome of PS/CC cancer is different from that of poorly differentiated endometrioid cancer. The purpose of this study was to compare the outcome between PS/CC and endometrioid International Federation of Gynecology and Obstetrics (FIGO) Grade 3 cancer and was limited to patients with Stage I-II uterine carcinoma.Methods and Materials: Between November 1987 and September 1999, 83 patients with Stage I endometrial cancer and Stage II occult endometrial cancer were treated with simple hysterectomy and high-dose-rate intravaginal brachytherapy. Forty-one patients (49%) had FIGO Grade 3 endometrioid tumors (Group 1) and 42 (51%) had PS/CC histologic features (Group 2). The mean age was 63 years (range 30-89). Comprehensive surgical staging was done in 23 (28%) of 83 patients. Capillary space-like invasion (CSLI) was seen in 24 (29%) of 83 patients. The median dose of intravaginal brachytherapy when used alone was 21 Gy in 3 fractions. Additional external beam radiotherapy was given to 42 (51%) of 83 patients to 45 Gy. The two groups were balanced with regard to age, race, comprehensive surgical staging, amount of myometrial involvement, CSLI, lower uterine segment involvement, cervical involvement, and use of external beam radiotherapy. The median follow-up was 46 months (range 4-147).Results: The pattern of relapse was as follows: vagina/pelvis in 5 of 14 patients, lungs in 8 of 15, intra-abdominal in 4 of 12, and supraclavicular lymph nodes in 1 of 14. One of the four intra-abdominal disseminations was in Group I and the other three in Group 2 (p = 0.6). The 5-year vaginal1pelvic control, disease-free survival (DFS), and overall survival (OS) rate was 93% (95% confidence interval [CI] 87-99%), 79% (95% CI 69-89%), and 74% (95% CI 64-85%), respectively. No significant difference in outcome was found between Groups 1 and 2. The 5-year vaginal/pelvic control rate was 97% (95% CI 91-100%) in Group 1 compared with 90% (95% CI 81-99%) in Group 2 (p = 0.2). The 5-year DFS rate was 79% (95% CI 64-95%) in Group 1 vs. 78% (95% CI 65-92%) in Group 2 (p = 0.6), and the 5-year OS rate was 71% (95% CI 55-87%) in Group 1 vs. 79% (95% CI 66-92%) in Group 2 (p = 0.3). The influence on outcome of age, race, comprehensive surgical staging, CSLI, amount of myometrial invasion, cervical involvement, lower uterine segment involvement, and presence of pure PS or CC histologic features was evaluated. On multivariate analysis, only CSLI correlated with poor DFS (P 0.04; relative risk 3, 95% CI 1-9) and OS (p = 0.02; relative risk 3, 95% CI 1-6).Conclusion: On the basis of the results of this study, no significant difference in outcome exists between patients with Stage-I-II endometrial cancer with PS/CC histologic features and those with similar stage disease, but with FIGO Grade 3 endometrioid histologic features. CSLI was the only independent predictor of poor DFS and OS. (C) 2002 Elsevier Science Inc.