子宫内膜癌Ⅰ级患者的手术分期  

Surgical staging for patients presenting with grade 1 endometrial carcinoma

作　　者：Ben-Shachar I. Pavelka J. CohnD.E. J.M.Fowler 王雅楠 

机构地区：[1]Dr.M-210 Starling Loving Hall, 320 West 10th Avenue, Columbus,OH 43210, United States

出　　处：《世界核心医学期刊文摘（妇产科学分册）》2005年第8期51-51,共1页Core Journal in Obstetrics/Gynecology

摘　　要：OBJECTIVE: To examine the impact of surgical staging of patients presenting with grade 1 endometrial cancer. METHODS: The charts of all patients who presented for surgery for endometrial cancer between March 1997 and July 2003 were analyzed for demographic data, final tumor histology, grade, stage, and complications. RESULTS: A total of 349 patients underwent surgical management for endometrial cancer. Preoperatively, 181 (52%) were identified with grade 1 disease, with a mean age of 61 years (range 27-89). Surgical staging (pelvic ±paraaortic lymphadenectomy) was performed in 82%of cases and was omitted only in cases when disease was apparently confined to the endometrium and surgical risk was high. In staged patients, 3.2%had severe surgical complications. There were 2 perioperative mortalities (1 pulmonary emboli and 1 myocardial infarct). In comparison of pre-and postoperative histology, 19%of patients were upgraded, with 15%grade 2, 0.5%grade 3, 2.5%serous or clear cell, and 1%mixed mesodermal tumor. Lymph node metastases were found in 3.9%of patients presenting with grade 1 endometrial cancer, and 10.5%had extrauterine spread (> IIb). High-risk uterine features, including myometrial invasion more than 1/2, grade 3 lesions, high-risk histologic variants, and/or cervical involvement, were found in 26%of the patients. No patients with stage Ia-IIb endometrioid cancer received adjuvant teletherapy or chemotherapy. Four patients with low-risk uterine features were found to have extrauterine disease. Twelve percent of patients received adjuvant therapy, and 17%avoided teletherapy and/or chemotherapy based on surgical staging. CONCLUSION: Surgical staging in patients presenting with grade 1 endometrial cancer significantly impacted postoperative treatment decisions in 29%of patients. Omitting lymphadenectomy in patients presenting with grade 1 endometrial cancer may lead to inappropriate postoperative management.OBJECTIVE: To examine the impact of surgical staging of patients presenting with grade 1 endometrial cancer. METHODS: The charts of all patients who presented for surgery for endometrial cancer between March 1997 and July 2003 were analyzed for demographic data, final tumor histology, grade, stage, and complications. RESULTS: A total of 349 patients underwent surgical management for endometrial cancer. Preoperatively, 181 (52%) were identified with grade 1 disease, with a mean age of 61 years (range 27-89). Surgical staging (pelvic ±paraaortic lymphadenectomy) was performed in 82%of cases and was omitted only in cases when disease was apparently confined to the endometrium and surgical risk was high. In staged patients, 3.2%had severe surgical complications. There were 2 perioperative mortalities (1 pulmonary emboli and 1 myocardial infarct). In comparison of pre-and postoperative histology, 19%of patients were upgraded, with 15%grade 2, 0.5%grade 3, 2.5%serous or clear cell, and 1%mixed mesodermal tumor. Lymph node metastases were found in 3.9%of patients presenting with grade 1 endometrial cancer, and 10.5%had extrauterine spread (> IIb). High-risk uterine features, including myometrial invasion more than 1/2, grade 3 lesions, high-risk histologic variants, and/or cervical involvement, were found in 26%of the patients. No patients with stage Ia-IIb endometrioid cancer received adjuvant teletherapy or chemotherapy. Four patients with low-risk uterine features were found to have extrauterine disease. Twelve percent of patients received adjuvant therapy, and 17%avoided teletherapy and/or chemotherapy based on surgical staging. CONCLUSION: Surgical staging in patients presenting with grade 1 endometrial cancer significantly impacted postoperative treatment decisions in 29%of patients. Omitting lymphadenectomy in patients presenting with grade 1 endometrial cancer may lead to inappropriate postoperative management.

关 键 词：手术分期 宫颈浸润 淋巴结切除 肿瘤组织学 透明细胞癌 中胚层瘤 治疗决策 肌层浸润 统计学资料 外科手术 

分 类 号：R737.33[医药卫生—肿瘤]