子宫下段受累可能为Ⅰ期内膜癌辅助放疗的不良预后因素

摘要

Objective To explore the effect of lower uterine segment involvement (LUSI) in predicting the prognosis of stageⅠendometrial carcinoma patients treated with postoperative radiotherapy .Methods The data of a total of 265 patients with stage Ⅰendometrial carcinoma treated with hysterectomy and adjuvant radiotherapy be -tween January 1999 and December 2012 were retrospectively analyzed .The median age of the cohort was 53 years.The most common pathological type was endometrioid adenocarcinoma (226/265, 85.3%).The patients were divided into two groups according to the presence of LUSI:LUSI group and non-LUSI group .The prognostic factors and treatment outcomes were compared between the two groups , subgroup analysis was conducted in the high-risk and high-intermediate-risk patients in the two groups .Primary outcomes were overall survival ( OS), progression-free survival ( PFS) , loco-regional recurrence ( LR) , distant metastasis ( DM) , and treatment failure (TF).The survival rates were calculated using the Kaplan-Meier method.The survival rates between different groups were compared using the Log-rank test .Prognostic factors for survival were analyzed using a Cox propor-tional hazards regression model .Results The 5-year OS and PFS for all the patients were 92.8%and 89.7%, respectively;the 5-year LR, DM, and TF were 4.5%, 6.4%, and 7.8%, respectively .Univariate analysis re-vealed that LUSI was a significant predictor of OS and PFS ( P=0.015 , 0.035 ) .Cox proportional hazard model demonstrated a significantly decreased OS and PFS in the LUSI group compared with the non -LUSI group ( P=0.041 , RR=0.346 , 95%CI:0.125-0.959;P=0.041 , RR=0.411 , 95%CI:0.175-0.963 ) .Subgroup univariate analysis showed that for high-risk and high-intermediate-risk patients, LUSI was a significant predictor of TF ( P=0.034 ) .Conclusions LUSI may be a significant predictor of reduced OS and PFS in patients with stage Ⅰ endometrial carcinoma treated with adjuvant radiotherapy .In addition, LUSI may be associated with treatment failure in high-risk and high-intermediate-risk patients .%目的：探讨子宫下段受累对Ⅰ期子宫内膜癌术后放疗患者的预后作用。方法回顾性分析1999年1月至2012年12月在北京协和医院进行术后放疗的Ⅰ期子宫内膜癌患者265例，中位年龄53岁，病理类型主要为子宫内膜样腺癌（226例，85.3％）。根据病理结果是否有子宫下段受累分为两组：子宫下段受累组和子宫下段未受累组，比较两组患者的预后因素和临床治疗结果，并对其中的高危和高中危患者进行亚组分析。主要研究终点包括总生存率、无进展生存率、局部区域复发率、远处转移率和治疗失败率。使用Kaplan-Meier法统计生存率，不同组间生存率的比较使用Log-rank检验，使用Cox比例风险回归模型进行预后因素分析。结果所有Ⅰ期内膜癌患者的5年总生存率和无进展生存率分别为92.8％和89.7％，5年局部区域复发率、远处转移率和治疗失败率分别为4.5％、6.4％和7.8％。单因素分析显示，子宫下段受累是影响总生存率和无进展生存率的相关因素（P＝0.015，0.035）。 Cox比例风险回归模型显示，子宫下段受累组患者的总生存率和无进展生存率更低（P＝0.041， RR＝0.346，95％ CI：0.125～0.959；P＝0.041， RR＝0.411，95％ CI：0.175～0.963）。亚组单因素分析显示，在高危和高中危患者中，子宫下段受累是影响治疗失败率的相关因素（ P ＝0.034）。结论子宫下段受累可能是影响Ⅰ期内膜癌辅助放疗患者总生存率和无进展生存率的不良预后因素；在高危和高中危患者中，子宫下段受累主要与治疗失败的发生相关。