摘要
目的探讨改良根治性/根治性子宫切除在降低Ⅰ期子宫内膜样腺癌局部复发中的价值。方法对1996年1月至2008年12月在本院行改良根治性/根治性子宫切除的Ⅰ期子宫内膜样腺癌临床病理资料进行回顾性分析,并随访患者的复发和生存情况。应用Kaplan-Meier法对所有患者的复发、生存情况进行分析。结果518例Ⅰ期子宫内膜样腺癌中474例行改良根治性/根治性子宫切除+双附件切除±盆腔淋巴结清扫±腹主动脉旁淋巴结清扫+腹水/腹腔洗液细胞学检查,12例(2.5%)患者术前接受放、化疗,73例(15.4%)患者术后补充放、化疗。中位随访30个月后,16例患者最终复发转移。8例远处转移,4例阴道残端复发,4例盆腔复发。3年、5年阴道残端累积复发率为1.4%和2.0%,局部复发(阴道+盆腔)比率为2.5%和3.1%,3年和5年的总生存率均为98.1%。Ⅰa、Ⅰb、Ⅰc期5年局部复发率分别为3%、3.7%和0(P=0.649),5年生存率分别为98.3%、97.8%和100%(P=0.399)。淋巴结清扫与否不影响局部复发率以及生存率(P值分别为0.525和0.665)。中位手术时间为135 min,中位出血量300 mL,输血比率为15.4%,术中、术后手术相关并发症为7.0%,无手术相关死亡病例。结论改良根治性/根治性子宫切除有效地提高了Ⅰ期子宫内膜样腺癌局控率,可望作为Ⅰ期子宫内膜样腺癌另一治疗选择,急需进行随机临床研究进一步证实其在Ⅰ期子宫内膜样腺癌治疗中的价值。
Objective The aim of this study was to find whether modified radical hysterectomy or radical hysterectomy improves local-regional control for patients with stage Ⅰ endometrioid carcinoma. Methods The medical records of patients with stage Ⅰ endometrioid carcinoma who were enrolled in Cancer Hospital of Fudan University between 1996 to 2008 after undergoing modified radical hysterectomy or radical hysterectomy were reviewed. The Kaplan-Meier method was used for time toevent analysis with recurrence and death as the end points. Results Among 518 women with stage Ⅰ endometrioid carcinoma, 474 underwent modified radical/radical hysterectomy and bilateral salpingo oophorectomy± pelvic lymphadenectomy ±peri-aortic lymphadenectomy ＋cytology. Twelve patients （2.5 %） received neoadjuvant chemotherapy or vaginal brachytherapy before operation, and 73 patients （15.4 %） received postoperative adjuvant therapy （pelvic external beam radiotherapy or chemotherapy or combination）. After a median follow-up of 30 months, 16 relapses were observed. Eight patients suffered with distant metastases, 4 with vaginal recurrences and 4 with pelvic recurrences. The 3-year and 5-year cumulative vaginal recurrence rates were 1.4% and 2.0%. The 3-and 5-year cumulative local-ragional recurrence rates were 2.5% and 3.1%. The 3-and 5-year actuarial overall survival rates were both 98.1%. The 5-year local-regional recurrence rates for stage Ⅰ a, stage Ⅰ b, stage Ⅰ c were 3%, 3. 7% and 0 （P = 0. 649）, and the 5-year survival rates were 98. 3%, 97. 8% and 100% （P = 0. 399）. There was no evidence of benefit in terms of lympnadenectomy in patients with stage Ⅰ endometrioid carcinoma（P value were 0. 525 and 0. 665, respectively）. The median operating time was 135 minutes, the median blood loss was 300 mL, and 15.4% of the patients needed blood transfusion. Surgery associated morbidity was 7%, and no one died of surgery associated morbidity. Conclusions Modified radical hysterectomy or radical hysterectomy is a viable and possibly preferable option for patients with stage Ⅰ endometrioid carcinoma. Randomized clinical trials were urgently needed to address the utility of modified radical hysterectomy in stage Ⅰ endometrial cancer.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2009年第6期746-752,共7页
Fudan University Journal of Medical Sciences
基金
上海市科委资助项目(08411961900)
