VAGINAL RECURRENCES OF ENDOMETRIAL CARCINOMA - THE PROGNOSTIC VALUE OF STAGING BY A PRIMARY VAGINAL-CARCINOMA SYSTEM
VAGINAL RECURRENCES OF ENDOMETRIAL CARCINOMA - THE PROGNOSTIC VALUE OF STAGING BY A PRIMARY VAGINAL-CARCINOMA SYSTEM
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DOI：
10.1016/0360-3016(88)90110-1
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发表时间：
1988-10-01
影响因子：
7
通讯作者：
FANNING, J
中科院分区：
文献类型：
--
作者：
CURRAN, WJ;WHITTINGTON, R;FANNING, J
1986 年之前在三个机构连续就诊的 1716 名子宫内膜癌女性中，有 55 名被发现有孤立的子宫切除术后阴道复发。他们的治疗包括对 26 名女性进行外部放射治疗 (RT) 和近距离放射治疗，对 17 名女性进行单独外部放射治疗，对 4 名女性进行近距离放射治疗，对 8 名女性不进行放射治疗。外部放射治疗/近距离放射治疗组合剂量范围为 2000 至 10,000 cGy，中位数为 6000 cGy。全组3年和5年精算生存率分别为48%和31%，3年和5年骨盆控制率分别为52%和42%。接受 .gtoreq 治疗的患者的 5 年生存率和骨盆控制率。总 RT 剂量中 6000 cGy 的比例为 47% 和 68%，而接受 < 6000 cGy 的患者的比例为 12% 和 10%（p = 0.002 和 p = 0.004）。接受第二次放疗的患者的 5 年生存率为 16%，而之前未接受放射治疗的患者的 5 年生存率为 48%。每次复发均采用国际妇产科联合会 (FIGO) 分期系统 Perez 修改版原发性阴道癌。其中I期病例15例（阴道粘膜），II期病例32例，其中IIA期（阴道下浸润）15例，IIB期（宫旁浸润）17例，III期病例（盆壁受累）8例。使用该分期系统的 3 年精算生存率和骨盆控制率为： I 期：85%/100%； II期：41%/43%，IIA期：59%/53%，IIB期：26%/35%；第三阶段：13%/0%。 I 期患者的这些结果终点显着优于 II 期患者（p = 0.01 和 0.0004），I 期和 IIA 期患者的这些结果终点显着优于 IIB 期和 III 期患者（p = 0.0005 和 0.002）。年龄、子宫切除术后间隔时间、初始分期和部位等治疗前变量并不能预测生存率，但观察到根尖复发的盆腔控制率高于尿道下复发（56% vs. 20%）。 III 级组织学与较差的生存率高度相关 (p = 0.0006)。这种阴道癌分期系统似乎对于预测子宫切除术后阴道复发患者的治疗结果具有价值。
Fifty-five of 1716 women with endometrial carcinoma seen consecutively at three institutions prior to 1986 were found to have an isolated post-hysterectomy vaginal recurrence. Their therapy included external radiation therapy (RT) and brachytherapy for 26 women, external RT alone for 17, brachytherapy only for 4, and no RT for 8. Combined external RT/brachytherapy doses ranged from 2000 to 10,000 cGy with a median of 6000 cGy. The 3- and 5-year actuarial survival rates are 48% and 31% for the entire group, and the 3- and 5-year pelvic control rates are 52% and 42%. The 5-year survival and pelvic control rates for those who received .gtoreq. 6000 cGy in total RT dose are 47% and 68%, compared with 12% and 10% for those receiving < 6000 cGy (p = 0.002 and p = 0.004). For patients receiving their second RT course, the 5-year survival rate is 16%, compared with 48% for those not previously irradiated. The Perez modification of the International Federation of Gynecology and Obstetrics (FIGO) staging system for primary vaginal carcinoma was applied to each recurrence. There were 15 Stage I cases (vaginal mucosa), 32 Stage II cases divided between 15 Stage IIA (subvaginal infiltration) and 17 in Stage IIB (parametrial infiltration), and 8 Stage III cases (pelvic wall involvement). The 3-year actuarial survival and pelvic control rates using this staging system are: Stage I: 85%/100%; Stage II: 41%/43%, Stage IIA: 59%/53%, Stage IIB: 26%/35%; Stage III: 13%/0%. These outcome endpoints are significantly better for Stage I than Stage II patients (p = 0.01 and 0.0004) and for Stages I and IIA compared to Stages IIB and III (p = 0.0005 and 0.002). The pre-treatment variables of age, interval since hysterectomy, initial stage, and location did not predict for survival, but a higher rate of pelvic control was observed for apical than for suburethral recurrences (56% vs. 20%). Grade III histology was highly correlated with poor survival (p = 0.0006). This vaginal carcinoma staging system appears to have value in predicting treatment outcome for patients with post-hysterectomy vaginal recurrences.