Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma?
Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma?
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DOI：
10.1016/j.ygyno.2011.11.049
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发表时间：
2012-04-01
影响因子：
4.7
通讯作者：
McMeekin, D. S.
中科院分区：
文献类型：
--
作者：
Nugent, E. K.;Bishop, E. A.;McMeekin, D. S.
目标.淋巴结（LN）状态在治疗和预测子宫内膜癌复发中的重要性仍存在争议。有几种预测模型可以利用子宫因素对风险组进行分层。我们的目的是确定LN状态如何影响复发和生存相比，子宫因素单独。对接受完整手术分期的临床1期子宫乳头状腺癌患者进行回顾性分析。根据PORTEC 1高中度风险（H-IR）标准（2个因素：年龄> 60岁，3级，> 50%001）、GOG-99 H-IR标准（年龄> 70+1个因素，年龄50-70+2个因素，任何年龄+3个因素：2级或3级，LVSI，> 50%DOI）和PORTEC 2标准评估患者。比较淋巴结受累率、复发率、PFS和OS。我们确定了352例临床1期患者，其中24%（87）为LN阳性。175例患者符合PORTEC 1合格性，66例符合H-IR标准。各组LN阳性率相似（18.4% vs 19.7%，p = 0.83），但复发率不同（7.4% vs 27.3%，p = 0.0004）。只有93例符合PORTEC 2治疗标准，LN状态、复发和合格性之间无相关性。188例患者符合GOG-99的H-IR合格标准，H-IR组的LN阳性和复发率高于GOG-99合格标准（34.6% vs 16.3%，p = 0.0004，28.3% vs 10.6%，p = 0.0002）。仅基于子宫特征的H-IR疾病患者具有淋巴结受累的实质性风险。了解LN状态可以更好地确定风险、预后和术后治疗。(C)2011 Elsevier Inc. All rights reserved.
Objectives. Controversy continues over the importance of lymph node (LN) status in treating and predicting recurrence in endometrial cancer. Several predictive models are available which use uterine factors to stratify risk groups. Our objective was to determine how LN status affects recurrence and survival compared to uterine factors alone.Methods. A retrospective review was performed of patients undergoing complete surgical staging for clinical stage 1 endometrioid adenocarcinoma of the uterus. Patients were assessed based on PORTEC 1 high intermediate risk (H-IR) criteria (2 factors : age > 60, grade 3, > 50% 001), GOG-99 H-IR criteria (age > 70+1 factor, age 50-70+2 factors, any age +3 factors: grade 2 or 3, LVSI, > 50% DOI), and PORTEC 2 criteria. Rates of nodal involvement, recurrence rates, PFS, and OS were compared.Results. We identified 352 clinical stage 1 patients with positive LN in 24% (87). 175 patients met PORTEC 1 eligibility and 66 met H-IR criteria. Rates of LN positivity were similar among groups (18.4% vs 19.7%, p = 0.83) but recurrence rates were dissimilar (7.4% vs 27.3%, p = 0.0004). Only 93 met PORTEC 2 criteria for treatment with no association between LN status, recurrence, and eligibility. 188 patients met H-IR eligibility criteria for GOG-99 with LN positive and recurrence rates higher in the H-IR group compared to GOG-99 eligible (34.6% vs 16.3%, p = 0.0004, 28.3% vs. 10.6%, p = 0.0002).Conclusions. Patients with H-IR disease based on uterine characteristics alone have substantial risk of nodal involvement. Knowledge of LN status may better define risk, prognosis, and postoperative treatment. (C) 2011 Elsevier Inc. All rights reserved.