摘要
目的：本文以回溯性研究將馬偕紀念醫院十一年來的病患重新病理分期為晚期子宮內膜癌病患的存活與治療的狀況做一分析整理，以提供未來治療方向的依據。 材料與方法：從1985年6月到1996年7月， 在馬偕紀念醫院癌症登記中共有174名子宮內膜癌的病患，重新將手術後病理報告及腹腔癌細胞檢查結果以國際婦產科聯盟期別系統分期後，25名病患為第Ⅲ期子宮內膜癌患，4名為第四期病人；年齡由40歲到79歲，中位數為 56 歲；臨床表現症狀中以不正常出血最為常見，佔21/29; 28名病患經過手術探查，有18位病患接受手術後輔助性放射治療，包括體外照射及陰道殘端腔內治療，照射總劑量分別為5040cGy 到 5940c 句與 2000cGy到3000cGy；追蹤期為2.5個月到161.3個月（中值為37.3個月），實際的累計存活曲線則依照Kaplan-Meier分析法求得，並採用Gehans Generalized wilcoxon test來檢測不同存活曲線的差異性。 結果：重新病理分期後有14名患者為第ⅢA 期、11名患者為第ⅣC期、1 名為第ⅣA期、 3名為第ⅣB期，全部病患五年整體的存活率為48.3%；第三期病患的五年存活率為52%；而4名第四期的患者有3名死亡；五年存活率在細胞分化度佳、淺肌層侵犯、輔助放療等情形下有顯著差異；高齡病息亦可見低的五年存活率，但未達顯著差異。 結論：本研究分析可知對晚期子宮內膜癌手術後放療的給與可提高存活率：年齡大者，病理期別與細胞分化度差的比率均較高，因而可能有較差的存活率；深部子宮肌層侵犯會明顯影響存活率，但可能與高比率的差細胞分化度與淋巴轉移有關；對於單獨的輸卵管戴卵巢侵犯的病患，應鼓勵其完成骨盆腔放療以取得較佳的存活機會；但是若有巨觀的子宮旁組織的侵犯，主動脈旁淋巴結轉移，第三級分化度與透明細胞癌或乳突狀漿液癌，更積極的輔助性治療如更大範圍的放療或化學治療等應即早使用。
並列摘要
Purpose: To evaluate the therapeutic results of stage Ⅲ and IV advanced endometrial carcinoma treated at Mackay Memorial Hospital over the past ten years. To address the future direction in the management of this disease. Materials and methods: From July 1985 to June 1996, 174 patients with pathologically proven endometrial cancer were registered. All patients were staged according to the 1988 FIGO staging system. There were 25 cases with stage Ⅲ disease and 4 patients with stage IV disease. The median age was 57 years with a range of 40-79 years. Abnormal vaginal bloody discharge (21/29) was the most common symptom. Twenty-eight patients received a surgical approach initially. Seventeen patients received adjuvant radiotherapy to the whole pelvis with doses ranging from 5040 cGy to 5940 cGy and vaginal cuff irradiation with doses ranging from 2000 cGy to 3000 cGy, respectively. The follow-up period ranged from 2.5 months to 161.3 months. The acturial five-year cumulative survival rate was evaluated according to the Kaplan-Meier method and significance was calculated according to the Gehans General Wilcoxan test. Results: Restaging showed 14 cases with stage ⅢA disease, 11 with stage ⅢC, 1 with stage IVA and 3 with stage IVB. The overall 5-year survival for all patients was 48.3%, and for stage Ⅲ patients was 52%. There were four patients with stage IV disease, three of them died during the follow-up. In addition, the overall 5- year survival rate was statistically higher in grade 1 and 2 than in grade 3 in superficial myometrial invasion and in the radiation group. Older aged patients did have a lower 5-year survival rate but it was not statistically significant. Conclusion: In patients with solitary extrauterine involvement, whole pelvis irradiation results in better survival. Gross adaexic involvement, para-aortic lymph node metastases and poordifferentiation or clear cell or papillary serous carcinoma have a more aggressive character, and so pelvic irradiation only as adjuvant therapy is inadequate. Therefore further aggressive therapy including extended-field irradiation, whole abdominal irradiation, hormonal therapy and chemotherapy should be considered.
延伸閱讀
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