| Objectives. Endometrial cancer is the most common gynecological malignancy. There are few studies on changing trends of clinicopathology,treatment and prognosis of endometrial cancer. Our primary objective was to evaluate the difference in survival for endometrial cancer patients from PUMCH during three time cohorts. The secondary objective was to assess whether patient and tumor characteristics or type of primary and adjuvant therapy had changed significantly during the same time periods and if these changes independently affected outcome.Methods. A total of 875 patients, all consecutive cases, primarily treated for endometrial cancer at Peking Union Medical College Hospital during the last 30 years(1/1/1981- 12/31/2010) have been investigated. Information of patients and tumor were collected retrospectively from records, including age, serum CA-125, FIGO stage, histology, histological grade, procedure type, risk factors, and following-up information. IBM SPSS 20.0 was used for statistical analysis.Results. A total of 29 patients(3.3%) from PUMCH were treated from 1981 to 1990, 178(20.3%) from 1991 to 2000 and 668(76.3%) from 2001 to 2010.(1) Patients were treated at a mean age of 55 years. Both age at diagnosis and menopausal status changed significantly over time(P=0.034, P=0.000).(2) Postmenopausal uterine bleeding and abnormal uterine bleeding were the most common first symptoms for endometrial cancer patients. The proportion of postmenopausal uterine bleeding was smaller over time, from 72.4% to 53.0%(P=0.001).(3) Pre-operation serum CA-125 had been used more frequently(P=0.000) and there had been more patients with elevated CA-125. The main diagnostic evidence still came from Dilation & Curettage, approximately 90.6% of all diagnostic methods.(4) Proportion of early and advanced stages of the whole cohort was 84.4% and15.6%, respectively, which was of no statistical significance(P=0.397).(5)Rate of positive lymph nodes had been decreasing(P=0.069) from 33.3%(3/9) to 19.7%(13/66) to 12.8%(52/406),while more and more complete staging including lymphadenectomy had been done(P=0.000).(6) Proportion of non-endometrioid endometrial cancer didn’t change significantly over time(P=0.532), neither did histological grade(P=0.332), G1-2 accounted for 92.6%,81.0% and 82.8% in three time cohorts. Clear cell carcinoma and serous carcinoma accounted for the biggest however, other types of non-endometrioid endometrial cancer had been rising.(7) Adjuvant therapy for endometrioid endometrial cancer changed a lot. During the intermediate 10 years, adjuvant radiotherapy was as wave hollow(18.9%,P=0.130) while endocrinal therapy was at wave peak(27.3%,P=0.000). Use of radiotherapy combined with chemotherapy had been increasing(P=0.000)from 83.3% to 13.9%.(8) Progression-free survival and overall survival had been improving during 30 years period. 5 year-PFS was 85.1%, 79.9% and 87.4% while 5 year- OS was 83.9%,92.3% and 95.3%.(9) There were some risk factors for recurrence, age≥55(P=0.000), menopausal status(P=0.001), non-endometrioid endometrial cancer(P=0.002),FIGO staging(P=0.000), deep myometrium invasive(P=0.010), histological grade(P=0.000), positive peritoneal cytology(P=0.003), and positive lymph nodes(P=0.000); In Cox model, histological grade(G3 referred to G1/2,P=0.010,RR=2.244,95% CI 1.210-4.163), FIGO stage III/IV(referred to stage I/II, P=0.001,RR=3.226,95% CI 1.593-6.532)were independent risk factors for recurrence.(10) There were some risk factors for death, age≥55(P=0.003), menopausal status(P=0.001), non-endometrioid endometrial cancer(P=0.001),FIGO staging(P=0.000), histological grade(P=0.000), deep myometrium invasive(P=0.033), positive peritoneal cytology(P=0.004), and positive lymph nodes(P=0.000),and time period(P=0.013); In Cox model, histological grade(G3 referred to G1/2, P=0.012,RR=3. 930,95% CI 1.359-11.364)were independent risk factors for death.Conclusion.(1) Age at diagnose was younger than foreign reports. There was a younger trending for the whole cohort. Proportion of pre-menopause was bigger than foreign reports and had been bigger. The most common symptom of endometrial cancer were post-menopausal uterine bleeding and abnormal uterine bleeding and the latter may resulted from younger age and more pre-menopausal patients.(2)Our main test for endometrial cancer was imaging methods combined with pre-operative serum CA-125 level. Use of CA-125 is enlarging. The main way to evaluate histology was Dilation & Curettage while hysteroscope tended to have been used more frequently.(3) Histology and histological grade proportion hadn’t changed a lot. More and more focus had been put on specific histology other than clear cell carcinoma and serous carcinoma.(4) There had been more and more pelvic and/or para-aortic lymphadenectomy, at the same time, positive rate had been decreasing.(5) Patients with risk factors or diagnosed at advanced stage should be treated with adjuvant therapies.(6) PFS and OS had been improved in PUMCH. |
PDF Full Text Request