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題名 | 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 |
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作者 | 王銘志; 吳孟浩; 張國華; 賴允亮; 鍾昌宏; 劉岱瑋; 陳裕仁; | 書刊名 | 放射治療與腫瘤學 |
卷期 | 4:1 1997.03[民86.03] |
頁次 | 頁17-22 |
分類號 | 417.27 |
關鍵詞 | 危險因子; 放射線治療; 子宮內膜癌; Risk factor; Radiotherapy; Endometrial carcinoma; |
語文 | 中文(Chinese) |
中文摘要 | 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 透明細胞癌都排除討論,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。這些危險因子包括ヾ子宮肌層被侵犯深度 大於二分一ゝ細胞分化第 3 級( G3 )ゞ子宮頸侵犯々腺鱗癌。 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。 在手術治療上,大部分的病 患接受子宮及兩側輸卵管卵巢切除術, 36 位接受放射線治療的病患,大部份接受手術後骨盆 外照射或配合陰道殘端腔內治療,其骨盆外照射總劑量為 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:在經過我們回朔性的研究顯示,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考。 |
英文摘要 | 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 designed a retrospective study for 143 patients with Stage I/II endometrial cancer treated at Mackay Memorial Hospital between 1984 and 1996. Patients were restaged according to the 1988 FIGO 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 cGy(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 B 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 B 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. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。