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目的探讨Ⅰ期子宫乳头状浆液性腺癌(UPSC)术后的有效补充治疗方法。方法对四川省肿瘤医院2006-2009年收治的16例Ⅰ期UPSC临床资料进行回顾性分析。结果 16例患者中Ⅰa期4例,Ⅰb期8例,Ⅰc期4例,术后至少随访2年。术前确诊的11例,均进行了全面分期手术。观察组3例(Ⅰa、Ⅰb、Ⅰc期各1例),其中1例Ⅰc期术后14个月阴道残端复发,2年内无瘤生存率为66.7%。术后单纯化疗组4例(Ⅰa、Ⅰb期各2例),均无复发,2年内无瘤生存率为100%。化疗+放疗组9例(Ⅰa期1例,Ⅰb期5例,Ⅰc期3例),其中1例未行阴道近距离放疗的Ⅰc期患者术后6个月阴道残端复发,2年内无瘤生存率为88.9%。2例阴道残端复发的Ⅰc期患者经补救治疗后随访至今均健在。结论对于进行了全面分期手术的病理分期为Ⅰa期的UPSC具有良好的预后,术后可予观察,不用补充治疗。对于Ⅰb期及Ⅰc期UPSC患者,化疗及阴道近距离放疗可能会降低远处转移及阴道残端复发的风险。但因研究病例数太少,术前未确诊的5例UPSC患者未行全面分期手术,尚存在一定局限性,将来需要进行更大规模的随机对照前瞻性研究。
Objective To investigate the effective supplementary treatment of stage Ⅰ uterine papillary serous adenocarcinoma (UPSC). Methods The clinical data of 16 stage Ⅰ UPSC patients admitted to Sichuan Cancer Hospital from 2006 to 2009 were analyzed retrospectively. Results Among the 16 patients, 4 cases were stage Ⅰa, 8 cases were stage Ⅰb and 4 cases were stage Ⅰc. The patients were followed up for at least 2 years. Preoperative diagnosed in 11 cases, were conducted a comprehensive staging. The observation group 3 cases (Ⅰ a, Ⅰ b, Ⅰ c of 1 cases), including 1c stage Ic 14 months after the recurrence of vaginal stump, 2-year disease-free survival rate of 66.7%. There were no recurrences in 4 cases (2 cases in stage Ⅰa and 1b) after chemotherapy. The 2-year disease-free survival rate was 100%. In the chemotherapy plus radiotherapy group, 9 cases (stage Ⅰa in 1 case, stage Ⅰb in 5 cases, stage Ⅰc in 3 cases), 1 case of stage Ⅰc without vaginal brachytherapy recurred vaginal stump 6 months after operation and no tumor within 2 years Survival rate was 88.9%. Two cases of recurrence of vaginal stump Ⅰc stage patients after follow-up after treatment are alive. Conclusions The UPSC with pathological staging stage Ia undergoing a comprehensive staging operation has a good prognosis and can be observed postoperatively without additional treatment. Chemotherapy and vaginal brachytherapy may reduce the risk of distant metastasis and recurrence of vaginal stump in stage Ib and stage Ic UPSC patients. However, due to the small number of cases and the uncorrected 5 cases of preoperative UPSC patients without complete staging surgery, there are some limitations, the future need for more large-scale randomized controlled prospective study.