CAJ | 학술논문

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.
목적 탐토개량근치성/근치성자궁절제재강저Ⅰ기자궁내막양선암국부복발중적개치.방법 대1996년1월지2008년12월재본원행개량근치성/근치성자궁절제적Ⅰ기자궁내막양선암림상병리자료진행회고성분석,병수방환자적복발화생존정황.응용Kaplan-Meier법대소유환자적복발、생존정황진행분석.결과 518례Ⅰ기자궁내막양선암중474례행개량근치성/근치성자궁절제+쌍부건절제±분강림파결청소±복주동맥방림파결청소+복수/복강세액세포학검사,12례(2.5%)환자술전접수방、화료,73례(15.4%)환자술후보충방、화료.중위수방30개월후,16례환자최종복발전이.8례원처전이,4례음도잔단복발,4례분강복발.3년、5년음도잔단루적복발솔위1.4%화2.0%, 국부복발(음도+분강)비솔위2.5%화3.1%,3년화5년적총생존솔균위98.1%.Ⅰa、Ⅰb、Ⅰc기5년국부복발솔분별위3%、3.7%화0 (P=0.649),5년생존솔분별위98.3%、97.8%화100% (P=0.399).림파결청소여부불영향국부복발솔이급생존솔(P치분별위0.525화0.665).중위수술시간위135 min,중위출혈량300 mL,수혈비솔위15.4%,술중、술후수술상관병발증위7.0%,무수술상관사망병례.결론 개량근치성/근치성자궁절제유효지제고료Ⅰ기자궁내막양선암국공솔,가망작위Ⅰ기자궁내막양선암령일치료선택,급수진행수궤림상연구진일보증실기재Ⅰ기자궁내막양선암치료중적개치.
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-to-event analysis with recurrence and death as the end points. Results Among 518 women with stage Ⅰendometrioid 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 Ⅰa, stage Ⅰb, stage Ⅰc 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.