目的：本文以回溯性研究將馬偕紀念醫院十一年來的病患重新病理分期為晚期子子宮內膜癌病患的存活與治療的狀況做一分析整理，以提供未來治療方向的依據。材料與方法：從 1985 年 6 月到 1996 年 7 月， 在馬偕紀念醫院癌症登記中共有 174 名子宮內膜癌的病患，重新將手術後病理報告及腹腔癌細胞檢查結果以國際婦產科聯盟期別系統分期後，25 名病患為第 III 　期子宮內膜癌患，4 名為第四期病人；年齡由 40 歲到79 歲，中位數為 56 歲；臨床表現症狀中以不正常出血最為常見，佔 21/29；28 名病患經過手術探查，有 18 位病患接受手術後輔助性放射治療，包括體外照射及陰道殘端腔內治療，照射總劑量分別為 5040 cGy 到 5940 cGy 與 2000 cGy 到 3000 cGy；追蹤期為 2.5 個月到 161.3 個月（中值為 37.3 個月）， 實際的累計存活曲線則依照 Kaplan-Meier 分析法求得，並採用 Gehans Generalized Wilcoxon test 來檢測不同存活曲線的差異性。結果： 重新病理分期後有 14 名患者為第 III A 期、11 名患者為第 III C 期、1 名為第IVN A 期、3 名為第 IV B 期。全部病患五年整體的存活率為 48.3%；第三期病患的五年存活率為 52%；而 4 名第四期的患者有 3 名死亡；五年存活率在細胞分化度佳、淺肌層侵犯、輔助放療等情形下有顯著差異；高齡病患亦可見低的五年存活率，但未達顥著差異。結論：本研究分析可知對晚期子宮內膜癌手術後放療的給與可提高存活率；年齡大者，病理期別與細胞分化度差的比率均較高，因而可能有較差的存活率；深部子宮肌層侵犯會明顯影響存活率，但可能與高比率的差細胞分化度與淋巴轉移有關；對於單獨的輸卵管或卵巢侵犯的病患，應鼓勵其完成骨盆腔放療以取得較佳的存活機會；但是若有巨觀的子宮旁組織的侵犯，主動脈旁淋巴結轉移，第三級分化度與透明細胞癌或乳突狀漿液癌，更積極的輔助性治療如更大範圍的放療或化學治療等應即早使用。

　　　　　Purpose:To evaluate the therapeutic results of stage III and IV advancedyears.To address the future direction in the management of this disease.Materials and methods: From July 1985 to June 1996, 174 patients withpathologically proven endometrial cancer were registered. All patients were stagedaccording to the 1988 FIGO staging system. There were 25 casse with stage IIIdisease and 4 patients with stage IV disease. The median age was 57 years with arange of 40-79 years. Abnormal vaginal bloody discharge (21/29) was the mostcommon symptom. Twenty-eight patients received a surgical approach initially.Seventeen patients received adjuvant radiotherapy to the whole pelvis with dosesranging from 5040 cGy to 5940 cGy and vaginal cuff irradiation with doses rangingfrom 2000 cGy to 3000 cGy, respectively. The follow-up period ranged from 2.5months to 161.3 months. The acturial five-year cumulative survival rate wasevaluated according to the Kaplan-Meier method and significance was calculatedaccording to the Gehans General Wilcoxon test.Results:Restaging showed 14 cases with stage IIIA disease, 11 with stage IIIC, 1with stage IVA and 3 with stage IVB. The overall 5-year survival for allpatients was 48.3%, and for stage III patients was 52%. There were four patientswith stage IV disease, three of them died during the follow-up. In addition, theoverall 5-year survival rate was statistically higher in grade 1 and 2 than ingrade 3 in superficial myometrial invasion and in the radiation group. Olderaged patients did have a lower 5-year survival rate but it was notstatistically significant.Conclusion:In patients with solitary extrauterine involvement, whole pelvisirradiation results in better survival. Gross adnexic involvement, para-aorticlymph node metastases and poordifferentiation or clear cell or papillary serousfarcinoma have a more aggressive character, and so pelvic irradiation only asadjuvant therapy diation, hormonal therapy and chemotherapy should beconsidered.