Study Of The Different Surgical Range And Prognosis For Stage I Endometrial Carcinoma

Background and Objective:Endometrial carcinoma is the common malignancy tumor in female reproductivetract,and it’s major method of therapy is operation.But there is a controversy in surgicalfashion and scope for early stage patients with endometrial carcinoma.The object of thestudy was to explore the influence of the surgical dissection extension andlymphadenectomy on prognosis of clinical stage I endometrial carcinoma,and toanalyse the prognostic factors of stage I endometrial carcinoma.Materials and Methods:Part one:131patients with clinical stage I endometrial carcinoma surgically treatedwere included from the Fist Affiliated Hospital of Fujian Medical University betweenJanuary2000to May2011in the study.74patients (group A) underwent simplehysterectomy and salpingo-oophorectomy with or without pelvic lymphadenectomy.The other57patients (group B) received sub-radical or radical hysterectomy andsalpingo-oophorectomy with or without pelvic lymphadenectomy.Influence of theprognosis was analysed according to thefollow-up date.Part two: Expect12patients with postoperative surgical stage Ⅱand above from131patients with clinical stage I endometrial carcinoma in the part one,collected andanalyzed the clinic and follow-up materials of119patients with stage I,and theprognostic factors were explored by univariate and multivariate methods.In dependentprognostic factor were identified by COX proportional Hazard regression medol,andthe overall survival were compared by Kaplan-Meier curve. Results:Part one:74patients (groupA) underwent simple hysterectomy and salpingo-oophorectomy,inwhich there were44patients(group A1) without pelviclymphadenectomy,and30patients(group A2）with pelvic lymphadenectomy.The other57patients (groupB)received sub-radical or radical hysterectomy and salpingo-oophorectomy,in whichthere were18patients (group B1) without pelvic lymphadenectomy,and39patients(group B2) with pelvic lymphadenectomy.(1)The five-year survival rate after operationof group A and group B were87%and76%,there were no significant differencesbetween the two groups.(2).There were also no significant differences between thegroup A1、group A2、group B1and group B2，when the five-year survival rate afteroperation of the follow-up groups were91%、78%、78%and76%.(3).There weresignificant differences between group A and group B in the operating time、blood loss、indwelling catheter days and postoperative hospital stay,the patients in group B had asignificantly longer operating time,more estimated blood loss,more slowly recovery ofbladder function,and a longer postoperative hospital stay than those in group A.(4).Therates of post-operative complicationsin in group B(33.33%) were significally higherthan in group A(16.2%).(5).There were no significant differences between group A andgroup B in the recurrence rate after operation.Part two:Five-year overall survival rate of119patients with stage I endometrialcarcinoma in part two was87%,10patients died up to the follow-up deadline date.Deep myometrial invasion, histological grade, pathological types,serumCA125,estrogen and progesterone receptor expression were identified as theinfluencing prognostic factors by univariate analysis, and deep myometrial invasion,histological grade, biological indicators were confirmed as the independent prognosticfactors by multivariate COX regression.Conclusion:(1).Surgical range is not the main factor influenced the survive of clinical stage Iendometrial carcinoma.Radical operation or lymphadenectomy will not increase thesurvival rate and reduce the relapse rate of stage I endometrial carcinoma significantly.(2).Radical operation or lymphadenectomy increases the incidence of complications ofclinical stage I endometrial carcinoma. (3).The high-risk group has a higer relapse rate after operation than the low-riskgroup,It’s necessary that the high-risk clinical stage I endometrial carcinoma patientsshoud be treated with postoperative adjuvant therapy.(4).Distant metastasis is remarkable,and should be considered in the adjuvant therapy.(5).deep myometrial invasion, histological grade, estrogen and progesterone receptorexpression are the independent prognostic factors for stage I endomentrial carcinoma.