中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2011年
8期
595-599
,共5页
任玉兰%王华英%单波儿%平波%施达仁
任玉蘭%王華英%單波兒%平波%施達仁
임옥란%왕화영%단파인%평파%시체인
子宫内膜肿瘤%细胞诊断学%腹水液%预后
子宮內膜腫瘤%細胞診斷學%腹水液%預後
자궁내막종류%세포진단학%복수액%예후
Endometrial neoplasms%Cytodiagnosis%Aseitie fluid%Prognosis
目的 探讨子宫内膜癌患者腹腔细胞学阳性的临床意义及对预后的影响.方法 对1996年1月至2008年12月复旦大学附属肿瘤医院收治的315例子宫内膜癌患者的临床病理资料进行回顾性分析,所有患者均行手术治疗,且均行术中腹水或腹腔冲洗液细胞学检查.对与腹腔细胞学阳性相关的因素,采用相关分析法进行分析;对影响子宫内膜癌患者预后的因素,采用log-rank检验进行单因素分析,采用Cox回归法进行多因素分析.结果 (1)315例子宫内膜癌患者中,30例(9.5%)患者腹腔细胞学阳性.腹腔细胞学阳性与多个子官内高危因素包括病理类型(P=0.013)、手术病理分期(P=0.000)、肌层浸润(P=0.012)、脉管浸润(P=0.012),以及多个子宫外转移危险因素包括子宫浆膜层侵犯(P=0.004)、宫颈受累(P=0.016)、附件转移(P=0.000)和大网膜转移(P=0.000)明显相关,而与病理分级(P=0.152)、淋巴结转移(P=0.066)无明显相关性.(2)315例子宫内膜癌患者的3年总生存率和3年无疾病进展生存率分别为93.0%和85.5%.单因素分析显示,腹腔细胞学阳性及不同手术病理分期、病理类型、肌层浸润深度、病理分级和脉管浸润是影响子宫内膜癌患者预后的危险因素(P＜0.05);多因素分析显示,手术病理分期、肌层浸润深度是影响子宫内膜癌患者预后的独立危险因素(P＜0.05).30例腹腔细胞学阳性患者中,无高危因素患者的3年生存率和3年无疾病进展生存率均显著高于有高危因素者(P＜0.05);进一步分析显示,腹腔细胞学阳性是影响晚期(Ⅲ～Ⅳ期)子官内膜癌患者预后的独立危险因素(P=0.006).结论 腹腔细胞学阳性与多个子宫内高危因素和子宫外转移危险因素密切相关,是影响晚期子宫内膜癌患者预后的独立危险因素.因此,腹水细胞学检查应继续作为全面分期手术的步骤之一,并将结果单独进行报告,是十分有必要的.
目的 探討子宮內膜癌患者腹腔細胞學暘性的臨床意義及對預後的影響.方法 對1996年1月至2008年12月複旦大學附屬腫瘤醫院收治的315例子宮內膜癌患者的臨床病理資料進行迴顧性分析,所有患者均行手術治療,且均行術中腹水或腹腔遲洗液細胞學檢查.對與腹腔細胞學暘性相關的因素,採用相關分析法進行分析;對影響子宮內膜癌患者預後的因素,採用log-rank檢驗進行單因素分析,採用Cox迴歸法進行多因素分析.結果 (1)315例子宮內膜癌患者中,30例(9.5%)患者腹腔細胞學暘性.腹腔細胞學暘性與多箇子官內高危因素包括病理類型(P=0.013)、手術病理分期(P=0.000)、肌層浸潤(P=0.012)、脈管浸潤(P=0.012),以及多箇子宮外轉移危險因素包括子宮漿膜層侵犯(P=0.004)、宮頸受纍(P=0.016)、附件轉移(P=0.000)和大網膜轉移(P=0.000)明顯相關,而與病理分級(P=0.152)、淋巴結轉移(P=0.066)無明顯相關性.(2)315例子宮內膜癌患者的3年總生存率和3年無疾病進展生存率分彆為93.0%和85.5%.單因素分析顯示,腹腔細胞學暘性及不同手術病理分期、病理類型、肌層浸潤深度、病理分級和脈管浸潤是影響子宮內膜癌患者預後的危險因素(P＜0.05);多因素分析顯示,手術病理分期、肌層浸潤深度是影響子宮內膜癌患者預後的獨立危險因素(P＜0.05).30例腹腔細胞學暘性患者中,無高危因素患者的3年生存率和3年無疾病進展生存率均顯著高于有高危因素者(P＜0.05);進一步分析顯示,腹腔細胞學暘性是影響晚期(Ⅲ～Ⅳ期)子官內膜癌患者預後的獨立危險因素(P=0.006).結論 腹腔細胞學暘性與多箇子宮內高危因素和子宮外轉移危險因素密切相關,是影響晚期子宮內膜癌患者預後的獨立危險因素.因此,腹水細胞學檢查應繼續作為全麵分期手術的步驟之一,併將結果單獨進行報告,是十分有必要的.
목적 탐토자궁내막암환자복강세포학양성적림상의의급대예후적영향.방법 대1996년1월지2008년12월복단대학부속종류의원수치적315례자궁내막암환자적림상병리자료진행회고성분석,소유환자균행수술치료,차균행술중복수혹복강충세액세포학검사.대여복강세포학양성상관적인소,채용상관분석법진행분석;대영향자궁내막암환자예후적인소,채용log-rank검험진행단인소분석,채용Cox회귀법진행다인소분석.결과 (1)315례자궁내막암환자중,30례(9.5%)환자복강세포학양성.복강세포학양성여다개자관내고위인소포괄병리류형(P=0.013)、수술병리분기(P=0.000)、기층침윤(P=0.012)、맥관침윤(P=0.012),이급다개자궁외전이위험인소포괄자궁장막층침범(P=0.004)、궁경수루(P=0.016)、부건전이(P=0.000)화대망막전이(P=0.000)명현상관,이여병리분급(P=0.152)、림파결전이(P=0.066)무명현상관성.(2)315례자궁내막암환자적3년총생존솔화3년무질병진전생존솔분별위93.0%화85.5%.단인소분석현시,복강세포학양성급불동수술병리분기、병리류형、기층침윤심도、병리분급화맥관침윤시영향자궁내막암환자예후적위험인소(P＜0.05);다인소분석현시,수술병리분기、기층침윤심도시영향자궁내막암환자예후적독립위험인소(P＜0.05).30례복강세포학양성환자중,무고위인소환자적3년생존솔화3년무질병진전생존솔균현저고우유고위인소자(P＜0.05);진일보분석현시,복강세포학양성시영향만기(Ⅲ～Ⅳ기)자관내막암환자예후적독립위험인소(P=0.006).결론 복강세포학양성여다개자궁내고위인소화자궁외전이위험인소밀절상관,시영향만기자궁내막암환자예후적독립위험인소.인차,복수세포학검사응계속작위전면분기수술적보취지일,병장결과단독진행보고,시십분유필요적.
Objective To evaluate the clinical significance of positive peritoneal cytology in patients with endometrial cancer.Methods The records of 315 patients with endometrial cancer who were operated at Cancer Hospital, Fudan University between January 1996 and December 2008 were reviewed.Peritoneal cytology were performed and diagnosed in all patients.Factors related with peritoneal cytology were analyzed by correlation analysis.Log-rank test and Cox regression test was used for the analysis of prognosis,respectively.Results (1) Peritoneal cytology were positive in 30 (9.5%) patients.Positive peritoneal cytology was associated with pathological subtype ( P = 0.013 ), stage ( P = 0.000 ), myometrial invasion ( P =0.012), lymph-vascular space invasion ( P = 0.012 ), serosal involvement ( P = 0.004 ), cervical involvement ( P = 0.016), adnexal involvement ( P = 0.000), and omental involvement ( P = 0.000), with no association with grade ( P = 0.152 ) and lymph node metastasis ( P = 0.066 ).( 2 ) Three-year overall survival (OS) and progression-free survival(PFS) were 93.0% and 85.5% ,respectively.Positive peritoneal cytology, surgical stage, pathological subtype, myometrial invasion, grade, and lymph-vascular space invasion were significantly associated with worse prognosis by univariate analysis ( P ＜ 0.05 ), while only surgical-pathology stage and myometrial invasion were independent prognostic factors by multivariate analysis ( P ＜ 0.05 ).For 30 cases with positive peritoneal cytology, the patients with no high risk factors shown significantly prognoses better than those with any risk factors.The results shown that for patients with late stage (stage Ⅲ - Ⅳ ) endometrial cancer with positive peritoneal cytology was significantly associated with the worse OS and PFS by multivariate analysis ( P = 0.006).Conclusions Positive peritoneal cytology was associated with serosal involvement, cervical involvement, adnexal involvement, omental involvement, and late stage.Therefore, peritoneal cytology should be performed and reported separately as a part of full surgical staging procedure.
