目的：探讨子宫内膜癌(EC)的临床病理学特征及淋巴结转移的预测因素。方法回顾性分析2007年3月至2010年4月四川大学华西第二医院妇科收治,并经术后组织病理学结果确诊为 EC 的358例患者的完整临床病历资料。其初治为系统分期手术,并进行盆腔及腹主动脉旁各组淋巴结计数。对本组EC患者进行临床病理特点分析,并进行随访,对EC盆腔淋巴结转移的可能相关因素进行统计学分析(本研究遵循的程序符合四川大学华西第二医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象本人的知情同意,并与之签署临床研究知情同意书)。结果本组358例 EC 患者的中位发病年龄为52岁(20~78岁)。对本组患者的中位随访时间为18个月,其中位生存期为18个月(7~43个月),3年总体生存(OS)率为90.1%(323/358)。本组盆腔淋巴结病理学检查结果呈阳性和呈阴性患者的3年 OS率分别为76.2%(16/21),97.3%(327/336),二者比较,差异有统计学意义(χ2=23.423,P<0.01)。子宫内膜样癌和非子宫内膜样癌患者的3年 OS率分别为：96.2%(306/318)与95.0%(38/40),差异无统计学意义(P=0.478)。国际妇产科联盟(FIGO)分期不同患者的3年 OS 率分别为：Ⅰ期为97.1%(304/313),而Ⅱ期为91.7%(11/12)；Ⅲ期为85.2%(23/27)。本组患者随访期内 EC 的相关复发率为3.9%(14/358),死亡率为3.1%(11/358),盆腔淋巴结转移率为5.9%(21/357)。对导致21例患者盆腔淋巴结转移的可能相关因素进行单因素 logistic 回归分析结果显示,FIGO 分期[OR=4.169,95%CI(2.693~6.454),P=0.000],肿瘤体积(肿瘤直径>2 cm)[OR=7.175,95%CI(2.590~19.876),P=0.000],淋巴脉管间隙浸润(LVSI)[OR=6.277,95%CI(2.410~16.348),P=0.000],宫体肌层浸润深度[OR=3.598,95%CI(1.651~7.841),P=0.001]和宫旁浸润[OR=9.382,95%CI(3.349~26.284),P=0.000]是导致 EC患者盆腔淋巴结转移的高危因素；对以上单因素 logical 回归分析结果显示,对盆腔淋巴转移有影响的因素(P<0.05),进行多因素非条件 logistic 回归分析结果显示,FIGO 分期[OR=3.787,95%CI (2.113~6.786),P=0.00]是盆腔淋巴结转移的独立危险因素。结论 FIGO 分期晚、肿瘤体积大(直径>2 cm)、LVSI呈阳性、宫体深肌层浸润及宫旁浸润是导致 EC患者发生盆腔淋巴结转移的高危因素。其中, FIGO分期,是盆腔淋巴结转移的独立危险因素。
目的：探討子宮內膜癌(EC)的臨床病理學特徵及淋巴結轉移的預測因素。方法迴顧性分析2007年3月至2010年4月四川大學華西第二醫院婦科收治,併經術後組織病理學結果確診為 EC 的358例患者的完整臨床病歷資料。其初治為繫統分期手術,併進行盆腔及腹主動脈徬各組淋巴結計數。對本組EC患者進行臨床病理特點分析,併進行隨訪,對EC盆腔淋巴結轉移的可能相關因素進行統計學分析(本研究遵循的程序符閤四川大學華西第二醫院人體試驗委員會所製定的倫理學標準,得到該委員會批準,徵得受試對象本人的知情同意,併與之籤署臨床研究知情同意書)。結果本組358例 EC 患者的中位髮病年齡為52歲(20~78歲)。對本組患者的中位隨訪時間為18箇月,其中位生存期為18箇月(7~43箇月),3年總體生存(OS)率為90.1%(323/358)。本組盆腔淋巴結病理學檢查結果呈暘性和呈陰性患者的3年 OS率分彆為76.2%(16/21),97.3%(327/336),二者比較,差異有統計學意義(χ2=23.423,P<0.01)。子宮內膜樣癌和非子宮內膜樣癌患者的3年 OS率分彆為：96.2%(306/318)與95.0%(38/40),差異無統計學意義(P=0.478)。國際婦產科聯盟(FIGO)分期不同患者的3年 OS 率分彆為：Ⅰ期為97.1%(304/313),而Ⅱ期為91.7%(11/12)；Ⅲ期為85.2%(23/27)。本組患者隨訪期內 EC 的相關複髮率為3.9%(14/358),死亡率為3.1%(11/358),盆腔淋巴結轉移率為5.9%(21/357)。對導緻21例患者盆腔淋巴結轉移的可能相關因素進行單因素 logistic 迴歸分析結果顯示,FIGO 分期[OR=4.169,95%CI(2.693~6.454),P=0.000],腫瘤體積(腫瘤直徑>2 cm)[OR=7.175,95%CI(2.590~19.876),P=0.000],淋巴脈管間隙浸潤(LVSI)[OR=6.277,95%CI(2.410~16.348),P=0.000],宮體肌層浸潤深度[OR=3.598,95%CI(1.651~7.841),P=0.001]和宮徬浸潤[OR=9.382,95%CI(3.349~26.284),P=0.000]是導緻 EC患者盆腔淋巴結轉移的高危因素；對以上單因素 logical 迴歸分析結果顯示,對盆腔淋巴轉移有影響的因素(P<0.05),進行多因素非條件 logistic 迴歸分析結果顯示,FIGO 分期[OR=3.787,95%CI (2.113~6.786),P=0.00]是盆腔淋巴結轉移的獨立危險因素。結論 FIGO 分期晚、腫瘤體積大(直徑>2 cm)、LVSI呈暘性、宮體深肌層浸潤及宮徬浸潤是導緻 EC患者髮生盆腔淋巴結轉移的高危因素。其中, FIGO分期,是盆腔淋巴結轉移的獨立危險因素。
목적：탐토자궁내막암(EC)적림상병이학특정급림파결전이적예측인소。방법회고성분석2007년3월지2010년4월사천대학화서제이의원부과수치,병경술후조직병이학결과학진위 EC 적358례환자적완정림상병력자료。기초치위계통분기수술,병진행분강급복주동맥방각조림파결계수。대본조EC환자진행림상병리특점분석,병진행수방,대EC분강림파결전이적가능상관인소진행통계학분석(본연구준순적정서부합사천대학화서제이의원인체시험위원회소제정적윤리학표준,득도해위원회비준,정득수시대상본인적지정동의,병여지첨서림상연구지정동의서)。결과본조358례 EC 환자적중위발병년령위52세(20~78세)。대본조환자적중위수방시간위18개월,기중위생존기위18개월(7~43개월),3년총체생존(OS)솔위90.1%(323/358)。본조분강림파결병이학검사결과정양성화정음성환자적3년 OS솔분별위76.2%(16/21),97.3%(327/336),이자비교,차이유통계학의의(χ2=23.423,P<0.01)。자궁내막양암화비자궁내막양암환자적3년 OS솔분별위：96.2%(306/318)여95.0%(38/40),차이무통계학의의(P=0.478)。국제부산과련맹(FIGO)분기불동환자적3년 OS 솔분별위：Ⅰ기위97.1%(304/313),이Ⅱ기위91.7%(11/12)；Ⅲ기위85.2%(23/27)。본조환자수방기내 EC 적상관복발솔위3.9%(14/358),사망솔위3.1%(11/358),분강림파결전이솔위5.9%(21/357)。대도치21례환자분강림파결전이적가능상관인소진행단인소 logistic 회귀분석결과현시,FIGO 분기[OR=4.169,95%CI(2.693~6.454),P=0.000],종류체적(종류직경>2 cm)[OR=7.175,95%CI(2.590~19.876),P=0.000],림파맥관간극침윤(LVSI)[OR=6.277,95%CI(2.410~16.348),P=0.000],궁체기층침윤심도[OR=3.598,95%CI(1.651~7.841),P=0.001]화궁방침윤[OR=9.382,95%CI(3.349~26.284),P=0.000]시도치 EC환자분강림파결전이적고위인소；대이상단인소 logical 회귀분석결과현시,대분강림파전이유영향적인소(P<0.05),진행다인소비조건 logistic 회귀분석결과현시,FIGO 분기[OR=3.787,95%CI (2.113~6.786),P=0.00]시분강림파결전이적독립위험인소。결론 FIGO 분기만、종류체적대(직경>2 cm)、LVSI정양성、궁체심기층침윤급궁방침윤시도치 EC환자발생분강림파결전이적고위인소。기중, FIGO분기,시분강림파결전이적독립위험인소。
Objective To study risk factors for pelvic lymph node metastasis in uterine endometrioid cancer(EC).Methods Single institution retrospective study of 358 patients with Federation International of Gynecology and Obstetrics (FIGO ) stage Ⅰ-Ⅳ EC. All patients were treated with primary surgery consisting of total abdominal (n = 326 ) or laparoscopic (n = 32 ) hysterectomy, bilateral salpingooophorectomy,pelvic and (or)paraaortic lymphadenectomy and peritoneal cytology.Follow-up methods were outpatient visit and telephone interview.Univariate and multivariate analyses to predict distant recurrence or survival from disease were performed comparing known risk factors.Multivariable logistic regression analysis identified predictors of pelvic lymph node metastasis.All tested for significance using two-tailed tests at theα= 0.05 level.Significance was set at the P<0.05 level in all analyses. Statistical analysis was carried out by means of the statistical package for the social sciences (SPSS)software version 18.0.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital,Sichuan University.Informed consent was obtained from all participants.Results The surgical-pathological stages among 358 patients were stage Ⅰ (n=313, 87.43%);stage Ⅱ(n=12,3.35%);stage Ⅲ(n=27,7.54%);stage Ⅳ(n=6,1.68%).The histological types include endometrioid (n=318,88.83%),and no-endometrioid adenocarcinoma(n=40,11.17%). The median age of 358 patients was 52 years old (20-78 years old).The median follow-up of 358 patients was 18 months,and their median overall survival (OS)time was 18 months (7-43 months).There had significant difference in rates of 3-year OS between patients with positive and negative of pathological results of pelvic lymph node [76.2%(16/21)vs.97.3%(327/336);χ2 =23.423,P<0.01].There had no significant difference in rates of 3-year OS between patients with endometrioid carcinoma and non endometrioid carcinoma[96.2%(306/318)vs.95.0%(38/40),P=0.478].The 3-year rates of OS among 358 patients was 90.1% (323/358).The 3-year rates of OS in patients of FIGO stage Ⅰ-Ⅲ were:StageⅠ, 97.1%;stage Ⅱ,91.7%;stage Ⅲ,85.2%.During the period of follow-up,mortality rate of 358 patients was 3.07%(25/358).On univariate logistic regression analysis,FIGO stage [OR=4.169,95%CI(2.693-6.454),P=0.000],tumor size[OR=7.175,95%CI(2.590-19.876),P=0.000],lymph vascular space invasion(LVSI)[OR=6.277,95%CI(2.410-16.348),P=0.000],depth of myometrial invasion[OR=3.598,95%CI(1.651-7.841),P=0.001]and parametrial invasion[OR=9.382 ,95%CI(3.349-26.284), P=0.000]were significantly associated with pelvic lymph node metastasis.On multivariate non conditional logistic regression analysis,FIGO stage [OR=3.787,95%CI(2.113-6.786),P=0.000]was highly associated with pelvic lymph node metastasis.Conclusions FIGO clinical stage,tumor size (diameter>2 cm),LVSI, depth of myometrial invasion, parametrial invasion were related to pelvic lymph node metastasis,and surgical-pathological stages were significantly associated with pelvic lymph node metastasis.
