Endometrioid uterine cancer: Histopathological risk factors of local and distant recurrence
Endometrioid uterine cancer: Histopathological risk factors of local and distant recurrence
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DOI：
10.1016/j.ygyno.2008.10.019
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发表时间：
2009-02-01
影响因子：
4.7
通讯作者：
Tanaka, Toshinobu
中科院分区：
文献类型：
--
作者：
Fujimoto, Toshio;Nanjyo, Hiroshi;Tanaka, Toshinobu
目标。目的探讨子宫内膜样子宫癌组织病理学预后因素与初始复发部位的关系。共有355例患者（I期，n=227； II期，n=38； III期，n=90）接受了包括全系统盆腔淋巴结（PLN）和主动脉旁淋巴结（PALN）腺切除术在内的原发性根治性手术，并伴有复发风险的辅助化疗。采用log-rank检验分析无复发生存期（RFS）和疾病相关生存期（DRS）。采用多因素Cox回归分析和logistic回归分析确定和估计独立预后因素。淋巴血管间隙浸润（LVSI）、建筑分级（AG）、肌层浸润和PLN转移（PLNM）被确定为RFS的独立预后因素。AG （p=0.0043）与局部复发相关。在接受辅助化疗的患者中，G3肿瘤患者复发率（16/45）高于g1 /2肿瘤患者（11/102）（p=0.0004）。PLNM与远处复发相关（p=0.0008）。按PLN阳性位点数（0组：n = 313, 1组：n = 16, >组=2:n =26）比较，RFS差异有统计学意义，5年RFS分别为91.9%,81.3%,41.2%。子宫内膜样子宫癌患者的初始复发部位与AG和PLNM有关。对于G3肿瘤和>= 2阳性PLN部位的患者，目前单独化疗可能不是预防复发的有效辅助治疗。需要进行前瞻性临床试验，以确定对这些患者的辅助治疗策略。(C) 2008爱思唯尔公司版权所有。
Objectives. To determine the relationship between histopathological prognostic factors and sites of initial recurrence in endometrioid uterine cancer.Methods. A total of 355 patients (Stage I, n=227; II, n=38; III, n=90) underwent primary radical surgery including complete systematic pelvic lymph node (PLN) and para-aortic lymph node (PALN) adenectomy followed by adjuvant chemotherapy who were at risk for recurrence. Relapse-free Survival (RFS) and disease-related survival (DRS) were analyzed using the log-rank testing. Multivariate Cox regression analysis and logistic regression analysis were used to determine and estimate independent prognostic factors.Results. Lymph-vascular space invasion (LVSI), architectural grade (AG), myometrial invasion, and PLN metastasis (PLNM) were identified as independent prognostic factors for RFS. AG (p=0.0043) related with local recurrence. Among patients who received adjuvant chemotherapy, patients with G3 tumor had higher ratio of recurrence (16/45) compared with G 1/2 tumor (11/102) (p=0.0004). Meanwhile, PLNM related with distant recurrence (p=0.0008). There was a statistically significant difference in RFS according to the number of positive PLN sites (group 0: n = 313, 1: n = 16, >= 2: n =26), five-year RFS in each group was 91.9%, 81.3%, and 41.2%, respectively.Conclusions. Sites of initial recurrence were related with AG and PLNM in patients with endometrioid uterine cancer. Current chemotherapy alone may not be an effective adjuvant therapy to prevent recurrence in patients with G3 tumor and >= 2 positive PLN sites. Prospective clinical trial needs to be conducted to establish the strategy of adjuvant therapy with these patients. (C) 2008 Elsevier Inc. All rights reserved.