The outcome of stage I-II clinically and surgically staged papillary serous and clear cell endometrial cancers when compared with endometrioid carcinoma
The outcome of stage I-II clinically and surgically staged papillary serous and clear cell endometrial cancers when compared with endometrioid carcinoma
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DOI：
10.1006/gyno.2000.5737
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发表时间：
2000-04-01
影响因子：
4.7
通讯作者：
Clarke-Pearson, DL
中科院分区：
文献类型：
--
作者：
Cirisano, FD;Robboy, SJ;Clarke-Pearson, DL
目的。本研究的目的是比较I-II期子宫内膜乳头状浆液性癌(PS)、透明细胞癌(CC)和子宫内膜样癌(EM)的生存率和复发率，并检验肌层侵犯对预后的影响。本文回顾了1967-1990年间在杜克大学医学中心接受子宫切除术的574例临床分期为I-II期的子宫内膜癌患者的临床、手术病理和生存资料，其中包括53例PS和18例CC(基于术后组织学)。在此分析之前，所有的分期材料都是可用的，并进行了重新检查，并对FIGO外科分期进行了回顾性分配。研究的预后变量包括年龄、分期、分级、子宫肌层侵犯、淋巴管间隙侵犯(LVSI)和组织学。比较PS和CC组织学亚型与EM、EM分级1(EM1)、EM分级2(EM2)和EM分级3(EM3)之间的差异。统计分析采用chi(2)、Fisher‘s Exact和Wilcoxon秩和检验、Cox回归分析和Kaplan-Meier生存分析。PS肿瘤占9%，CC占3%，EM占88%。PS组(38%)和CC组(22%)的复发率高于EM组(9%)(P<0.001)，PS组的复发率高于EM组(20%)(P=0.06)。在PS、CC和EM3复发患者中，术前或术后接受放疗或化疗的比例没有统计学差异。生存时间较短的预后因素包括：年龄=60岁，手术分期III+IV，左心室综合征的存在，组织学(PS、CC或EM3)，以及肌层侵犯的50%。PS+CC患者的估计5年生存率
Purpose. The aim of this study was to compare survival and recurrence in clinical and surgical stage I-II papillary serous (PS), clear cell (CC), and endometrioid (EM) cancers of the endometrium and examine the prognostic utility of myometrial invasion.Methods. Clinical, surgicopathologic, and survival data were retrospectively collected on 574 clinical stage I-II endometrial cancer patients, including 53 PS and 18 CC (based on postoperative histology), undergoing hysterectomy at Duke University Medical Center between 1967 and 1990. All staging material was available and reexamined prior to this analysis, and FIGO surgical staging was retrospectively assigned. Prognostic variables examined included age, stage, grade, myometrial invasion, lymph-vascular space invasion (LVSI), and histology. PS and CC histologic subtypes were compared as both common category and discrete categories versus EM, EM grade 1 (EM1), EM grade 2 (EM2), and EM grade 3 (EM3). Statistical analyses were performed using chi(2), Fisher's exact, and Wilcoxon rank sum tests, Cox regression analysis, and Kaplan-Meier survival analysis.Results. PS tumors accounted for 9%, CC for 3%, and EM for 88% of cases. Recurrences were more frequent among PS (38%) and CC (22%) compared with EM (9%) (P < 0.001 and 0.08, respectively), and PS recurred more frequently than EM3 alone (20%) (P = 0.06). Among PS, CC, and EM3 patients with recurrences there were no statistical differences in the proportion that received preoperative or postoperative radiotherapy or chemotherapy. Prognostic factors for shorter survival included age >=60, surgical stage III+IV, presence of LVSI, histology (PS, CC, or EM3), and >=50% myometrial invasion. The estimated 5-year survival of PS+CC patients with