PORTEC-2 更新表明，大量淋巴管-血管侵袭 (LVSI) 和异常 p53 表达 (p53abnl) 预示着较差的结果，这些患者应接受外照射治疗 (EBRT)。我们旨在确定具有这些风险因素并进行淋巴结 (LN) 评估的患者是否显示类似的结果。我们回顾性地研究了126例根据FIGO 2009年IA 3级、IB 1-2级以及IIIC期(阳性LN但无其他II/III期风险因素)子宫内膜型子宫内膜癌的患者，他们接受了LN评估。采用竞争风险方法分析局部复发 (LR)、区域复发 (RR) 和远处转移，使用Kaplan-Meier分析总生存 (OS)。中位随访时间为37.2个月。患有p53abnl表达与未患有该表达的患者之间的总生存有显著差异 (16.7%对3.1%死亡)，以及患有LVSI与未患有LVSI的患者之间有显著差异 (11.1%对1.5%死亡；均p < 0.01)。2年局部复发的累积发生率对比p53abnl与野生型p53和有LVSI与无LVSI的患者分别为11.1%（95% CI 0-25.6）对2.2%（95% CI 0-5.25；p = 0.04）和11.4%（95% CI 2.0-20.9）对0%（p < 0.01）。有LVSI与无LVSI的患者2年的区域复发累积发生率分别为6.9%（95% CI 0-14.4）对0%（p = 0.05）。完成盆腔 RT 的患者未出现区域内复发。尽管进行了LN评估，早期高中危险分期或仅有阳性淋巴结而无其他II或III期风险因素的IIIC期子宫内膜型子宫内膜癌的患者在p53abnl表达和/或LVSI存在的情况下有较差的预后。这些患者可能从EBRT的加强治疗中获益，以改善局部和盆腔控制。版权所有 © 2023。由Elsevier Inc.出版。

The PORTEC-2 update suggested that substantial lymphovascular space invasion (LVSI) and abnormal p53 expression (p53abnl) predict for poorer outcomes and that these patients should be treated with external beam radiation therapy (EBRT). We aim to determine if patients with these risk factors who undergo a lymph node (LN) assessment show similar outcomes.We retrospectively reviewed 126 patients with FIGO 2009 stage IA grade 3, stage IB grade 1-2, and stage IIIC (positive LN but no other stage II/III risk factors) endometrioid endometrial cancer who underwent LN assessment. Local (LR), regional recurrences (RR), and distant metastases were analyzed using competing risk methods, and overall survival (OS) was analyzed using Kaplan-Meier.Median follow-up time was 37.2 months. OS was significantly different between patients with and without p53abnl expression (16.7% versus 3.1% deceased), and between patients with and without LVSI (11.1% versus 1.5% deceased; p < 0.01 for both). The 2-year cumulative incidence of LR for patients with p53abnl versus wild type p53 and LVSI versus no LVSI was 11.1% (95% CI 0-25.6) versus 2.2% (95% CI 0-5.25; p = 0.04), and 11.4% (95% CI 2.0-20.9) versus 0%, respectively (p < 0.01). The 2-year cumulative RR in patients with LVSI versus no LVSI was 6.9% (95% CI 0-14.4) versus 0% (p = 0.05). No patients who completed pelvic RT experienced an in-field recurrence.Despite LN assessment, patients with high-intermediate risk early-stage or stage IIIC (with positive lymph nodes only but no other stage II or III risk factors) endometrial cancer with p53abnl expression and/or LVSI have worse outcomes. These patients may derive benefit from intensification with EBRT to improve local and pelvic control.Copyright © 2023. Published by Elsevier Inc.