CAJ | 학술논문

目的探讨年龄≤40岁Ⅰ期子宫内膜癌患者保留卵巢的安全性。方法回顾性分析中国医学科学院肿瘤医院1999年1月至2012年1月收治的75例年龄≤40岁的Ⅰ期子宫内膜癌患者的临床病理资料，根据术中是否保留卵巢分为保留卵巢组（20例）及切除卵巢组（55例），比较分析两组的临床病理特征及预后。结果保留卵巢组中13例患者保留双侧卵巢、7例保留单侧卵巢。保留卵巢组与切除卵巢组在发病年龄、体质指数、手术病理分期、病理类型、病理分级、腹水或腹腔冲洗液细胞学结果及术后治疗方式等方面比较，差异均无统计学意义（ P＞0.05）；而术前血CA125水平升高保留卵巢组有5例（25％，5／20），切除卵巢组为10例（18％，10／55），两组比较，差异有统计学意义（P＝0.029）。切除卵巢组行盆腔淋巴结切除或活检术的比例显著高于保留卵巢组[分别为35％（7／20）、84％（46／55）]，两组比较，差异有统计学意义（P＜0.01）。75例患者的中位随诊时间为31.7个月（0～160个月），共有2例患者复发。保留卵巢组与切除卵巢组患者5年总生存率（分别为100.0％、100.0％）和5年无瘤生存率（分别为90.0％、95.5％）比较，差异无统计学意义（ P＝0.579）。结论保留卵巢对年轻Ⅰa期、分化好的子宫内膜样腺癌患者的生存无显著影响。对此类患者保留卵巢的安全性仍需大规模前瞻性临床研究进一步证实。
목적탐토년령≤40세Ⅰ기자궁내막암환자보류란소적안전성。방법회고성분석중국의학과학원종류의원1999년1월지2012년1월수치적75례년령≤40세적Ⅰ기자궁내막암환자적림상병리자료，근거술중시부보류란소분위보류란소조（20례）급절제란소조（55례），비교분석량조적림상병리특정급예후。결과보류란소조중13례환자보류쌍측란소、7례보류단측란소。보류란소조여절제란소조재발병년령、체질지수、수술병리분기、병리류형、병리분급、복수혹복강충세액세포학결과급술후치료방식등방면비교，차이균무통계학의의（ P＞0.05）；이술전혈CA125수평승고보류란소조유5례（25％，5／20），절제란소조위10례（18％，10／55），량조비교，차이유통계학의의（P＝0.029）。절제란소조행분강림파결절제혹활검술적비례현저고우보류란소조[분별위35％（7／20）、84％（46／55）]，량조비교，차이유통계학의의（P＜0.01）。75례환자적중위수진시간위31.7개월（0～160개월），공유2례환자복발。보류란소조여절제란소조환자5년총생존솔（분별위100.0％、100.0％）화5년무류생존솔（분별위90.0％、95.5％）비교，차이무통계학의의（ P＝0.579）。결론보류란소대년경Ⅰa기、분화호적자궁내막양선암환자적생존무현저영향。대차류환자보류란소적안전성잉수대규모전첨성림상연구진일보증실。
Objective To investigate the safety of ovarian preservation for stage Ⅰ endometrial carcinomas in women aged 40 years and younger.Methods Seventy-five cases of stage Ⅰ endometrial cancer aged 40 years and younger from Jan 1999 to Jan 2012 were treated in Cancer Hospital , Chinese Academy of Medical Sciences.They were further divided into two groups:20 patients who underwent ovarian preservation (group A) and 55 patients who underwent oophorectomy (group B).Clinical and pathological recordings of these patients were reviewed and compared.Results In the group A , there were 13 patients preserved both ovaries , and 7 patients preserved a single ovary.While there were no significant differences in the age, body mass index, surgical staging, histology, grade, cytology of peritoneal lavage or ascites , and postoperative treatment between two groups ( all P>0.05 ).The differences in the level of CA 125 [ 25%(5/20) versus 18%(10/55)] and number of patients underwent pelvic lymphadenectomy [35% (7/20) versus 84%(46/55)] were statistically significant between two groups (all P<0.05).Of seventy-five cases, only two patients relapsed and all survived after a median follow-up time of 31.7 months ( range:0 to 160 months).Kaplan-Meier analysis revealed no difference in overall survival (100.0% versus 100.0%) and disease free survival ( 90.0% versus 95.5%) between two groups ( P =0.579 ).Conclusions Ovarian preservation has no statistically significant impact on the survival of young patients with stage Ⅰa, well differentiated endometrial cancer.Large-scale, prospective clinical studies are needed to validate the safety of ovarian preservation for those patients.