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

Lower Uterine Segment Involvement as a Predictor for Poor Prognosis in Patients Receiving Adjuvant Radiotherapy for Stage Ⅰ Endometrial Carcinoma

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。

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＆amp;nbsp;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 .