早期子宮內膜癌的治療與預後因子

Treatment Result and Prognostic Factor in Early Stage Endometrial Carcinoma

王銘志(Ming-Chih Wang) ； 吳孟浩(Meng-Hao Wu) ； 張國華(Kou-How Chang) ； 賴允亮(Yuen-Liang Lai) ； 鍾昌宏(Chang-Hung Chung) ； 劉岱瑋(Tai-Wei Liu) ； 陳裕仁(Yu-Jen Chen)

《放射治療與腫瘤學》 4卷1期 (1997/03) Pp. 17-22

https://doi.org/10.6316/TRO/199704(1)17

摘要

目的：探討早期子宮內膜癌手術與手術合併放射治療的存活率及各種預後因子。
材料與方法：我們將1984年6月至1996年7月間在馬偕醫院接受治療的143位早期子宮內膜癌的病患做回溯性的研究，並且再根據FIGO分期系統重新分期，乳突狀漿液癌和透明細胞癌都排隊討論，共計135位病患進入本研究之分析。如果患者具有下列一項以上危險因子，則視為高危險群，否則視為低危險群。這些危險因子包括①子宮肌層被侵犯深度大於二分之一②細胞分化第3級(G3)③子宮頸侵犯④腺鱗癌。在這135位病患中A組有99位病患接受手術治療，其中8位病患(8%)為高危險群，B組有36位病患接受手術合併放射線治療，其中30位病患(83%)為高危險群，大部份接受手術後骨盆外照射或配合陰道殘端腔內治療，其骨盆外照射線劑量為4000-5400厘葛雷(cGy)（平均為5013厘葛雷），至於陰道殘端腔內治療，每次劑量為至黏膜下0.5公分處給予500厘葛雷，總劑量為1000-3000厘葛雷（平均為2933厘葛雷）。
結果：經過6-147個月追蹤（中位數為62），五年整體存活率A組為96.9%，B組為89.3%。經由單變數因子分析臨床上影響存活因素以年齡大於55歲、子宮肌肉層侵犯程度大於二分之一及停經為存活率降低之重要預後因子，而多變數因子分析上，子宮肌肉層侵犯程度大於二分之一為存活率降低之重要預後因子，而其他因子則皆無統計學上的意義。在A組99位病患中有2位復發，其五年局部控制率為98%；在B組36位病患中有4位復發，其五年局部控制率為88%。
結論：在經過我們回溯性的研究顯示，對於早期子宮內膜癌的治療上，選擇性對於高危險群的病患，給予手術合併放射線治療，臨床上有令人滿意的效果及發現重要預後因子，值得做為進一步前瞻性研究的參攷。

關鍵字

危險因子 ； 放射線治療 ； 子宮內膜癌

並列摘要

Aims: To evaluation prognostic factors and treatment outcome for early stage endometrial cancer patients treated with surgery or combined surgery and radiation therapy (RT)
Material and Methods: We desinged a retrospective study for 143 patients with StageI/II endometrial cancer treated at Mackay Memorial Hospital between 1984 and 1996. Patients were restaged according to the 1988 EGO staging system. Patients with papillary serous, and clear cell histologies were excluded. Patients were considered as high risk group if they had one or more of the following factors: grade 3 tumor differentiation, depth of myometrial invasion＞1/2, pathologic cervical involvement, or adenosquamous histology. Of these 135 patients, 99 patients was treated with surgery alone (Group A) and the other 36 patients were treated with combined surgery and RT (Group B). Eight (8%) patients in group A and thirty (82%) patients in group B were defined high risk group. The main treatment modality consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy and/or postoperative external pelvic RT with/without intracavitary brachytherapy. The total dose of external pelvic irradiation is 4000-5400 cGy (median: 5013 cGy). Intracavity brachytherapy was given with 500 cGy per fraction prescribed to a depth of 0.5 cm under mucosal surface and the total dose was 1000-3000 cOy (median: 2933 cGy).
Results: Follow- up duration ranged from 6 to 147 months (median: 62 months). The 5-year overall survival rate in group A and group 13 were 96.9% and 89.3%, respectively. Univariate analysis identified the following significant prognostic factors: age, menopausal status and myometrial invasion. Multivariate analysis revealed myometrial invasion more than half of the thickness to be the only factor significant for reduce overall survival. Two of the 99 patients of group A had tumor relapse. The local control rate is 98%. Four of the 36 patients of group 13 had tumor relapse. The local control rate is 88%. Conclusion: Our retrospective study revealed good outcome associated with selective treatment combing surgery and RT for high risk patients. We also confirmed some important prognostic factors associated with survival. Base on the results of our study, further prospective study for the role of adjuvant radiation therapy for early stage endometrial cancer patient can be designed.

並列關鍵字

Risk Factor ； Radiotherapy ； Endometrial Carcinoma