Prognostic Factors Associated With Recurrence in Clinical Stage I Adenocarcinoma of the Endometrium
Prognostic Factors Associated With Recurrence in Clinical Stage I Adenocarcinoma of the Endometrium
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与临床 I 期子宫内膜腺癌复发相关的预后因素
DOI：
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发表时间：
1991
影响因子：
7.2
通讯作者：
D. S. Miller
中科院分区：
文献类型：
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作者：
J. Lurain;Brenda L. Rice;A. Rademaker;L. Poggensee;J. Schink;D. S. Miller
对1979年7月至1988年8月期间接受初次手术治疗的264例临床I期子宫内膜腺癌患者进行了前瞻性随访，并评估了8-112个月（平均51.5个月）的疾病复发情况。33例患者（12.57c）复发或死于疾病。在单因素统计分析中，与疾病复发显著相关的预后因素如下：（平均68.6年与60.3年无复发; P= 0.0001）;组织学（腺癌8.8%，腺鳞癌35.7%，乳头状25%，透明细胞57.1%; P<.0001）;肿瘤分级（1级，7.7%，2级，10.5%，3级，36.1%; P<.0001）;肌层浸润深度（无9.87 c，小于一半7.4%，大于或等于一半29.6%; P=.0001）;淋巴结状态（阴性8.3%，阳性47.6%;P<.0001）;非淋巴结性子宫外疾病扩散（缺失11.0%，存在50%; P=.0003）;腹膜细胞学检查（阴性9.4%，阳性26.37c; P= 0.004）和肿瘤大小（2cm或更小7%，大于2cm 17.3%P = 0.05）。宫颈延长和子宫大小对复发无明显影响。采用多变量分析，3级肿瘤（P= 0.002），年龄增长（P= 0.004），淋巴结转移（P= 0.006），子宫外疾病扩散而不是淋巴结转移（P= 0.038）是与疾病复发或死亡显著相关的唯一变量。这项研究支持国际妇产科联合会新的子宫内膜癌手术分期系统。7.4%（15/202）的手术I期患者复发，7例手术II期患者无复发，32.7%（18/55）的手术III期患者复发（P<.0001）。
Two hundred sixty-four consecutive patients with clinical stage I endometrial adenocarcinoma who underwent primary surgical therapy between July 1979 and August 1988 were followed prospectively and evaluated for disease recurrence for 8-112 months (mean 51.5). Thirty-three patients (12.57c) developed recurrence or died of disease. In univariate statistical analysis, prognostic factors significantly associated with disease recurrence were as follows: age (mean 68.6 years with versus 60.3 years without recurrence; P=.0001); histology (adenocarcinoma 8.8%, adeno-squamous 35.7%, papillary 25%, clear-cell 57.1%; P<.0001); tumor grade (grade 1, 7.7%, grade 2, 10.5%, grade 3, 36.1%; P<.0001); depth of myometrial invasion (none 9.87c, less than one-half 7.4%, one-half or greater 29.6%; P=.0001); lymph node status (negative 8.3%, positive 47.6%;P<.0001); non-nodal extrauterine disease spread (absent 11.0%, present 50%; P=.0003); peritoneal cytology (negative 9.4%, positive 26.37c; P=.004), and tumor size (2 cm or less 7%, greater than 2 cm 17.3% P=.05). Cervical extension and uterine size had no significant effect on recurrence. Using multivarlate analysis, grade 3 tumor (P=.002), advancing age (P=.004), lymph node metastasis (P=.006), and presence of extrauterine disease spread other than lymph node metastasis (P=.038) were the only variables significantly associated with disease recurrence or death. This study supports the new International Federation of Gynecology and Obstetrics surgical staging system for endometrial cancer. Recurrence developed in 7.4% (15 of 202) of patients with surgical stage I disease, none of seven patients with surgical stage II disease, and 32.7% (18 of 55) of patients with surgical stage III disease (P<.0001)