【摘要】 目的探讨具有高危因素的Ⅰ期子宫内膜癌术后辅助化疗的临床意义。方法对95例Ⅰ期子宫内膜癌患者的临床病理资料进行回顾性分析,比较高危组患者与低危组患者的复发及生存情况,分析化疗对Ⅰ期子宫内膜癌患者预后的影响。结果 95例患者中有20例(21.1%)行术后辅助化疗。高危组中14例(14/24,58.3%)行术后辅助化疗。95例患者治疗后复发10例(10.5%),其中高危组4例(4/24,16.7%),低危组6例(6/71,8.5%),两组比较无显著性差异(P>0.05);高危组的中位复发时间为13个月(11~23),低危组的中位复发时间为36个月(9~77),两组比较有显著性差异(P﹤0.05)。行术后辅助化疗的高危组患者复发1例(7.1%),为盆腔复发;未行术后辅助化疗的高危组患者复发3例(30%),均为盆腔合并远处转移(P>0.05)。高危组患者的5年无瘤生存率为79.5%,低危组患者为90.4%(P>0.05)。高危组患者的5年总生存率为64.9%,低危组患者为97.1%(P=0.005)。行术后辅助化疗的高危组患者的3年无瘤生存率和3年总生存率分别为90.0%、88.9%,优于未行术后辅助化疗的高危组患者(分别为64.8%、83.3%)。结论具有高危因素的Ⅰ期子宫内膜癌患者术后应给予恰当的辅助治疗。化疗有利于减少高危Ⅰ期子宫内膜癌的远处转移。更多还原

【Abstract】 Objective To assess the efficacy of postoperative adjuvant chemotherapy in patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ endometrial cancer with high-risk factors for unfavorable prognosis. Methods A retrospective review of 95 FIGO stage Ⅰ endometrial cancer patients treated between 1996 and 2006 in Beijing Cancer Hospital was performed. All patients underwent surgery, of which 20 patients underwent adjuvant chemotherapy. The patients were divided into high-risk and low-risk groups based on the high-risk prognostic factors (non-endometrial adenocarcinoma, tumor grade G3, outer half myometrial invasion, lymph-vascular space involvement). Actuarial techniques were used for the survival and recurrence rates. Results Eight of ten recurrences occurred in patients who did not receive postoperative chemotherapy, in which six were long-term failure. In the remaining two patients who were in the chemotherapy group were pelvic recurrence. Disease recurrence occurred in 4 (16.7%) of 24 high-risk group patients. The 5-year disease-free survival and the 5-year overall survival for the low-risk group were 90.4% and 97.1% respectively, which were 79.5% and 64.9% for the high-risk group (P > 0.05, P = 0.005, respectively). Compared to surgery alone, patients with high-risk factors who underwent surgery followed by chemotherapy had a trend to improved 3-year disease-free survival and 3-year overall survival (90.0% vs. 64.8%, 88.9% vs. 83.3%, respectively). Conclusion It is possible that the high-risk FIGO stage Ⅰ endometrial cancer patients should be treated with postoperative adjuvant chemotherapy to decrease long-term failure and improve prognosis.更多还原