[A risk score for operated endometrial cancer and its importance for adjuvant radiotherapy (histopathology and results of treatment based on 208 cases with pelvic lymph node excision)].
In a retrospective study of 208 surgically treated cases of endometrial cancer with pelvic lymphadenectomy, histomorphology with subtypes, tumour grading, infiltration of the myometrium, blood- and lymphatic vessel invasion and pelvic lymph node metastases, were analysed. Typical adenocarcinomas had lymph node involvement in 9% of the patients, whereas unfavourable subtypes showed in 27%. In patients with tumour grading I, the lymph nodes were involved in only 4.5% and with grading 3 in 31.4%, respectively. If the carcinoma was limited to the endometrium, no lymph node metastases could be detected. If the inner half of the myometrium was involved, pelvic nodes were positive in 9.2% with deeper infiltration in 27.3% of the cases. With obvious invasion of blood or lymph vessels, lymph nodes were positive in 43.2% of the cases. A simple score for these histopathological risk factors is proposed, enabling the allocation to patient groups of similar risk on the basis of a point system for individual prognostic factors. With a score of 1-2 points (13.5% of the cases) the prognosis is good and adjuvant irradiation does not seem necessary. With 3-4 points (34.1% of the cases), local vaginal irradiation is recommended. With 5 or more points, we recommended, in addition to vaginal irradiation, aggressive irradiation of the small pelvis, 52.4% were in this group, from which 85% were symptom-free at the critical 5 year point. In case of positive pelvic lymph node, 67% of the patients survived after adequate adjuvant follow-up irradiation.
Kucera
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Strahlenabteilung der I. und II. Universitäts-Frauenklinik Wien.
Vavra
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D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D004717:Endometrium / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009360:Neoplastic Cells, Circulating; D011879:Radiotherapy Dosage; D012307:Risk Factors; D015996:Survival Rate
Ein Risiko-Score für das operierte Endometriumkarzinom und seine Bedeutung für die adjuvante Strahlentherapie (Histopathologie und Behandlungsergebnisse anhand von 208 Fällen mit pelviner Lymphonodektomie).