Abstract：
BACKGROUND: Limited data suggests lower uterine segment involvement (LUSI) in endometrial cancer may be associated with other poor prognostic factors. We assessed the unclear impact of LUSI on prognosis in endometrial cancer.
METHODS: ology: A revision of pathological samples following surgical staging between the years 2002-2022 was performed and clinical data collected from patients\' records. Characteristics and outcomes of women with and without LUSI were compared and analysed. Kaplan Meyer survival curves compared overall survival (OS) and progression-free survival (PFS).
RESULTS: 429 women were included, of which 45 (10.5%) had LUSI. No differences were found between the groups regarding demographic or clinical characteristics. LUSI was significantly associated with lympho-vascular space invasion (40% vs. 22% p = 0.01), lymph node involvement (6.4% vs. 9.1%, p = 0.05), shorter PFS (4 vs. 5.5 years, p = 0.01) and OS (5.6 vs. 11.5 years, p = 0.03). Multivariate analysis showed higher hazard ratios for OS and PFS (1.55 95%CI 0.79-3.04 and 1.29 95%CI 0.66-2.53, respectively) but these were insignificant even in a sub-analysis of endometrioid histology (1.76 95%CI 0.89-3.46 and 1.35 95%CI 0.69-2.65, respectively). A trend towards decreased PFS and OS was demonstrated in the Kaplan Meyer survival curves for all cases (log rank test p = 0.5 and 0.29 respectively), endometrioid histology (log rank test p = 0.06 and 0.51 respectively) and early-stage disease (log rank test p = 0.63 and 0.3 respectively).
CONCLUSIONS: LUSI may be related to poorer outcome of endometrial cancer and may represent an additional factor to consider when contemplating adjuvant treatment, especially in endometrioid-type and early-stage disease.
METHODS: ology: A revision of pathological samples following surgical staging between the years 2002-2022 was performed and clinical data collected from patients\' records. Characteristics and outcomes of women with and without LUSI were compared and analysed. Kaplan Meyer survival curves compared overall survival (OS) and progression-free survival (PFS).
RESULTS: 429 women were included, of which 45 (10.5%) had LUSI. No differences were found between the groups regarding demographic or clinical characteristics. LUSI was significantly associated with lympho-vascular space invasion (40% vs. 22% p = 0.01), lymph node involvement (6.4% vs. 9.1%, p = 0.05), shorter PFS (4 vs. 5.5 years, p = 0.01) and OS (5.6 vs. 11.5 years, p = 0.03). Multivariate analysis showed higher hazard ratios for OS and PFS (1.55 95%CI 0.79-3.04 and 1.29 95%CI 0.66-2.53, respectively) but these were insignificant even in a sub-analysis of endometrioid histology (1.76 95%CI 0.89-3.46 and 1.35 95%CI 0.69-2.65, respectively). A trend towards decreased PFS and OS was demonstrated in the Kaplan Meyer survival curves for all cases (log rank test p = 0.5 and 0.29 respectively), endometrioid histology (log rank test p = 0.06 and 0.51 respectively) and early-stage disease (log rank test p = 0.63 and 0.3 respectively).
CONCLUSIONS: LUSI may be related to poorer outcome of endometrial cancer and may represent an additional factor to consider when contemplating adjuvant treatment, especially in endometrioid-type and early-stage disease.
摘要：
背景：有限的数据提示子宫内膜癌累及子宫下段（LUSI）可能与其他不良预后因素有关。我们评估了LUSI对子宫内膜癌预后的影响。
方法：生物学：在2002-2022年间进行手术分期后，对病理样本进行了修订，并从患者记录中收集了临床数据。比较和分析了有和没有LUSI的女性的特征和结果。KaplanMeyer存活曲线比较了总存活期(OS)和无进展存活期(PFS)。
结果：包括429名女性，其中45人（10.5%）患有LUSI。在人口统计学或临床特征方面，两组之间未发现差异。LUSI与淋巴血管间隙侵犯显著相关(40%vs.22%p=0.01)，淋巴结受累（6.4%vs.9.1%，p=0.05)，较短的PFS（4vs.5.5年,p=0.01）和OS（5.6vs.11.5年,p=0.03)。多变量分析显示OS和PFS的风险比更高（分别为1.5595CI0.79-3.04和1.2995CI0.66-2.53），但即使在子宫内膜样组织学的亚分析中，这些风险比也不重要（分别为1.7695CI0.89-3.46和1.3595CI0.69-2.65）。所有病例的KaplanMeyer存活曲线显示了PFS和OS下降的趋势（对数秩检验p分别为0.5和0.29），子宫内膜样组织学（对数秩检验p分别为0.06和0.51）和早期疾病（对数秩检验p分别为0.63和0.3）。
结论：LUSI可能与子宫内膜癌预后较差有关，并且可能是考虑辅助治疗时需要考虑的另一个因素。尤其是子宫内膜样型和早期疾病。
方法：生物学：在2002-2022年间进行手术分期后，对病理样本进行了修订，并从患者记录中收集了临床数据。比较和分析了有和没有LUSI的女性的特征和结果。KaplanMeyer存活曲线比较了总存活期(OS)和无进展存活期(PFS)。
结果：包括429名女性，其中45人（10.5%）患有LUSI。在人口统计学或临床特征方面，两组之间未发现差异。LUSI与淋巴血管间隙侵犯显著相关(40%vs.22%p=0.01)，淋巴结受累（6.4%vs.9.1%，p=0.05)，较短的PFS（4vs.5.5年,p=0.01）和OS（5.6vs.11.5年,p=0.03)。多变量分析显示OS和PFS的风险比更高（分别为1.5595CI0.79-3.04和1.2995CI0.66-2.53），但即使在子宫内膜样组织学的亚分析中，这些风险比也不重要（分别为1.7695CI0.89-3.46和1.3595CI0.69-2.65）。所有病例的KaplanMeyer存活曲线显示了PFS和OS下降的趋势（对数秩检验p分别为0.5和0.29），子宫内膜样组织学（对数秩检验p分别为0.06和0.51）和早期疾病（对数秩检验p分别为0.63和0.3）。
结论：LUSI可能与子宫内膜癌预后较差有关，并且可能是考虑辅助治疗时需要考虑的另一个因素。尤其是子宫内膜样型和早期疾病。
