目的:评估累及附件的子宫内膜癌患者的临床病理特征和生存结局。全厚度浆膜,或联合参与。
方法:这个国际,多机构,回顾性研究检查了2009年国际妇产科联合会(FIGO)IIIA期子宫内膜癌和涉及子宫浆膜和/或附件的肿瘤患者,他们在2000年至2019年之间进行了手术。肉瘤组织学患者,并发子宫内膜/卵巢恶性肿瘤,新辅助治疗,阳性淋巴结,或腹膜疾病被排除。
结果:在确认的185例患者中,139只患有附件肿瘤,40只含浆膜,和六个合并附件/浆膜受累。诊断时的中位年龄为60岁(范围23-89)。在子宫内膜样组织学肿瘤中,仅浆膜的12例(48%)和仅附件的17例(19%)为FIGO3级(p=0.007)。23例仅浆膜(64%)和50例仅附件(37%)受累的肿瘤有淋巴血管侵犯(p=0.004)。非子宫内膜样组织学表现在五个肿瘤(83%)与附件/浆膜结合,15(38%)仅浆膜,和50(36%)仅有附件参与。中位随访时间为77个月(范围0.6-254)。所有IIIA期患者的5年无进展生存率和总生存率分别为73.8%(SE3.5%)和81.0%(SE3.1%)。分别。对于仅附件的患者,仅浆膜,以及附件/浆膜联合受累,5年无进展生存率为80%(SE3.8%),61%(SE8.3%),和33%(SE19.2%),分别(p<0.01);5年总生存率为85%(SE3.3%),70%(SE7.8%),和60%(SE21.9%),分别(p=0.09)。在单变量分析中,浆膜受累有/无附件受累的肿瘤,非子宫内膜样组织学,和淋巴管浸润与疾病进展显著相关。在多变量分析中,浆膜受累伴/不伴附件受累的肿瘤仍与复发显著相关(校正后HR=2.2,95%CI1.2~4.3;p=0.01).
结论:2009年FIGOIIIA期子宫内膜癌患者根据附件和/或浆膜受累有不同的生存结局。调整组织学后,浆膜受累患者的无进展生存率较差,辅助治疗,和淋巴管间隙侵入.
OBJECTIVE: To assess clinicopathologic features and survival outcomes of patients with endometrial carcinoma involving adnexal, full-thickness serosal, or combined involvement.
METHODS: This international, multi-institutional, retrospective study examined patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IIIA endometrial cancer and tumors involving the uterine serosa and/or adnexa, who were surgically staged between 2000 and 2019. Patients with sarcoma histology, concurrent endometrial/ovarian malignancy, neoadjuvant treatment, positive lymph nodes, or peritoneal disease were excluded.
RESULTS: Of 185 patients identified, 139 had tumors with adnexal-only, 40 with serosal-only, and six with combined adnexal/serosal involvement. Median age at diagnosis was 60 years (range 23-89). Among tumors of endometrioid histology, 12 (48%) with serosal-only and 17 (19%) with adnexal-only involvement were FIGO grade 3 (p=0.007). Twenty-three tumors with serosal-only (64%) and 50 with adnexal-only (37%) involvement had lymphovascular invasion (p=0.004). Non-endometrioid histology was present in five tumors (83%) with combined adnexal/serosal, 15 (38%) with serosal-only, and 50 (36%) with adnexal-only involvement.Median follow-up was 77 months (range 0.6-254). Five-year progression-free survival and overall survival rates for all patients with stage IIIA disease were 73.8% (SE 3.5%) and 81.0% (SE 3.1%), respectively. For patients with adnexal-only, serosal-only, and combined adnexal/serosal involvement, 5-year progression-free survival rates were 80% (SE 3.8%), 61% (SE 8.3%), and 33% (SE 19.2%), respectively (p<0.01); 5-year overall survival rates were 85% (SE 3.3%), 70% (SE 7.8%), and 60% (SE 21.9%), respectively (p=0.09). On univariate analysis, tumors having serosal involvement with/without adnexal involvement, non-endometrioid histology, and lymphovascular invasion were significantly associated with progression. On multivariate analysis, tumors having serosal involvement with/without adnexal involvement remained significantly associated with recurrence (adjusted HR=2.2, 95% CI 1.2 to 4.3; p=0.01).
CONCLUSIONS: Patients with 2009 FIGO stage IIIA endometrial cancer have distinct survival outcomes depending upon adnexal and/or serosal involvement. Progression-free survival was worse for patients with serosal involvement after adjusting for histology, adjuvant treatment, and lymphovascular space invasion.