Background:Although grade is a well-recognised prognostic factor for endometrioid endometrial cancer (EEC), in more studies grade 1 (G1) and grade 2 (G2) EEC are combined and compared together with grade 3 (G3) tumours. The aim of our study is to separately investigate the outcomes, prognostic factors and recurrence patterns of G2 EEC and whether the differentiation between G1 and G2 EEC is clinically useful.Methods:we retrospectively reviewed 523 patients with EEC treated with primary surgery over a decade (March 2010–January 2020) at Oxford University Hospitals NHS Trust, focusing on those with G2 disease.Results:Patients with G2 EEC had worse 5-year cancer-specific survival (93.3% vs. 98.5%,p< 0.01) compared to patients with G1 EEC, but a favourable prognosis compared to G3 EEG, both in terms of disease-free survival (91.6 vs. 83.8%,p= 0.04) and cancer-specific survival (93.3% vs. 78.5%,p< 0.01). Both stage and grade are independent risk factors for cancer-specific mortality in EEC. Cervical stromal involvement, parametrial involvement and distant metastatic disease are all independent risk factors for cancer-related mortality in G2 ECC. Only 12.5% of recurrences of G2 EEC were diagnosed with examination in routine follow up in asymptomatic patients.Conclusions:our results suggest that the grading system should continue to differentiate G1 EEC and G2 EEC for better prognosis interpretation.
背景：虽然分级是子宫内膜样腺癌（EEC）公认的预后因素，但更多研究将1级（G1）与2级（G2）EEC合并后与3级（G3）肿瘤进行比较。本研究旨在分别探讨G2级EEC的临床结局、预后因素及复发模式，并分析G1与G2级EEC的区分是否具有临床价值。 方法：我们回顾性分析了牛津大学医院NHS信托基金会在十年间（2010年3月至2020年1月）接受初次手术治疗的523例EEC患者，重点关注其中G2级病例。 结果：与G1级EEC患者相比，G2级患者的5年癌症特异性生存率较低（93.3% vs. 98.5%，p<0.01），但与G3级EEC相比仍具有更优预后，体现在无病生存率（91.6% vs. 83.8%，p=0.04）和癌症特异性生存率（93.3% vs. 78.5%，p<0.01）两方面。分期与分级均为EEC癌症特异性死亡率的独立危险因素。宫颈间质浸润、宫旁浸润及远处转移均是G2级EEC癌症相关死亡的独立危险因素。仅12.5%的G2级EEC复发是通过无症状患者常规随访检查发现的。 结论：我们的研究结果表明，分级系统应继续区分G1与G2级EEC，以更准确地进行预后评估。
肿瘤(癌症)患者之家