The Value Of Modified Radical Hysterectomy In Intermediate Risk Subgroup Of FIGO Stage â…  Endometroid Adenocarcinoma

Objective:To study the therapeutic value of modified radical hysterectomy In intermediate risk subgroup of FIGO stage I endometroid adenocarcinoma patients in terms of local control, endometrial carcinoma-specific survival, surgical safety, surgery-related complications.Materials and methods:Retrospectively analysis the data of patients with endometroid adenocarcinoma initially treated with modified hysterectomy in Fudan University Cancer Hospital from January 2004 to December, screen the patient of intermediate-risk for recurrence. Apply Kaplan-Meier method to analyze the recurrence and survival; Apply COX regression to analyze the prognostic factors. Analyze the surgery related data and complications.Results:Up to 328 patients of FIGO 2009(Federation International of Gynecology and Obstetrics)stage I intermediate risk of endometroid adenocarcinoma initially underwent modified radical hysterectomy+ bilateral oophorectomy±pelvic lymphadenectomy±aortic lymph node dissection+ascites/peritoneal cytology。There were 168 cases of intermediate risk patient, of which 38 cases in the HIR (High-intermediate risk) subgroup,130 cases in LIR (Low-intermediate risk) subgroup. The median follow-up time was 69.5 months (50.8-85.25 months); 9patients recurrenced,3 local recurrence(vaginal or pelvic recurrence); 6 distant metastases;3 patients died of endometrial cancer. Off all the patients who recurrenced, the median recurrence-free survival was 40 months (17-46 months), and the median survival time was 65 months (27-78.5 months); 3- and 5-year cumulative isolated local recurrence rate were both 1.4%, endometrial cancer-specific survival rate were 98.6% and 97.8%. In HIR and LIR groups,3- and 5-year cumulative isolated local recurrence rates were 0 and 0 vsl.7% and 1.7%(x2=0.825, P=0.346); endometrial cancer-specific survival rate were 100% and 96.3% vs 98.2% and 98.2% (x2 =0.242, P=0.623). Of the intermediate risk patients who didn’t receive adjuvant therapy,3- and 5-year cumulative isolated local recurrence rates were both 1%; endometrial cancer-specific survival rate were 99.0% and 98.0%. Of the HIR patients who didn’t receive adjuvant therapy,3-and 5-year cumulative isolated local recurrence rates were boths o; endometrial cancer-specific survival rate were 100% å'Œ 90%. Of the LIR patients who didn’t receive adjuvant therapy,3-and 5-year cumulative isolated local recurrence rates were both 1.1%; endometrial cancer-specific survival rate were 98.9%. The operation time, blood loss and transfusion rate of the 168 cases of intermediate-risk patients:the median operative time was 130min (107-150min), the median blood loss was 300ml (200-400ml),21 patients received blood transfusion during surgery, blood transfusion rate was 12.5%. Surgery related complication rate was 4.8% and the genitourinary system complication rate was 1.8%.Conclusions:In the intermediate risk group of this study, there are only a small proportion of patient received adjuvant therapy after modified radical hysterectomy, but the local control effect and the survival benefit were good, and the surgery-related morbidity rate was low.