ANALYSIS OF PROGNOSTIC FACTORS AND OF TYPE OF TREATMENT IN PATIENTS WITH ENDOMETRIAL CANCER IN THE FIRST FIGO STAGE

Abstract

Cilj rada. Ispitati važnost histopatoloških čimbenika rizika i svrsishodnost načina liječenja u bolesnica s rakom endometrija u kirurškom – FIGO stadiju I. Metode. Retrospektivno je izdvojeno 219 bolesnica s rakom endometrija u kojih je učinjen sveobuhvatni staging (lavat negativan, limfne žlijezde negativne). Srednja dob bolesnica iznosila je 59 godina (SD 8, min. 39, maks. 75 godina). Vrijeme promatranja iznosilo je od 1 do 180 mjeseci, medijana 68 mjeseci. Analizirani su u odnosu na petogodišnje preživljenje sljedeći prognostički čimbenici: dob bolesnice, dubina invazije miometrija, histologija i diferenciranost tumora, vrsta histerektomije i primjena adjuvantne radioterapije. U 85 bolesnica učinjena je radikalna histerektomija, dok je njih 55 primilo adjuvantnu radioterapiju. Rezultati. Ukupno preživljenje promatrane skupine bolesnica iznosi 92,8%. Analizom svih prognostičkih parametara nije nađena značajnost u razlici preživljenja. Od 219 bolesnica njih 82 (37,4%) imale su kumulativne negativne prognostičke čimbenike, slabo diferencirani tumor ili neendometrioidni histološki nalaz ili invaziju miometrija preko polovice, a preživljenje između visoko rizične i nisko rizične skupine se bitno ne razlikuje (93,9% odnosno 91,2%). Primjena radikalne histerektomije uz adjuvantnu radioterapiju ne daje bolje rezultate preživljenja od radikalne histerektomije. Zaključak. Prema našoj retrospektivnoj analizi čimbenika rizika u bolesnica s rakom endometrija prvog FIGO stadija, analizirani čimbenici rizika nemaju prognostičko obilježje. Primjena radikalne histerektomije s ili bez adjuvantne radioterapije zdjelice ne pruža bolje rezultate u smislu preživljenja, i daljnju primjenu treba temeljito preispitati.Objective. To analyze the effect of histopathologic characteristics and usefullness of therapy mode in FIGO stage I endometrial cancer patients. Methods. Retrospectively were analyzed 219 endometrial cancer patients with hysterectomy, salpingoophorectomy and pelvic lymphadenectomy (peritoneal cytology and nodes negative). Patients characteristics include age, myometrial invasion, FIGO substages, histologic type, tumor grade, type of hysterectomy and adjuvant radio¬therapy. The mean age was 59 years (SD 8, Min. 39, Max. 75 years). Follow up ranges from 1 to 180 months (median 68). In 85 patients radical hysterectomies were performed and 45 patients received adjuvant radiotherapy. Results. Five year disease related survival was 92,8%. There is no significant difference among analyzed histopathologic patient’s characteristics related to five years survival. In 82 (37.3%) patients out of 219 were found cumulative negative prognostic factors (high risk patients) including non-endometrioid histology, poor tumor differentiation and/or outer half of miometrial invasion. There is no difference in survival between low (91,2%) and high risk patients (93,9%). Radical hysterectomy as well as adjuvant radiotherapy has no advantage in five year survival. Conclusion. This retrospective study has not identified histopathologic prognostic significant characteristics in FIGO stage I endometrial cancer patients. The use of radical hysterectomy and/or adjuvant radiotherapy has not better five years survival and should be reevaluated