中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2014年
6期
455-459
,共5页
李明珠%王志启%赵丽君%李小平%王建六%张春芳%魏丽惠
李明珠%王誌啟%趙麗君%李小平%王建六%張春芳%魏麗惠
리명주%왕지계%조려군%리소평%왕건륙%장춘방%위려혜
子宫内膜肿瘤%肿瘤复发,局部%预后
子宮內膜腫瘤%腫瘤複髮,跼部%預後
자궁내막종류%종류복발,국부%예후
Endometrial neoplasms%Neoplasm recurrence,local%Prognosis
目的 探讨影响Ⅰ~Ⅱ期子宫内膜癌患者复发及预后的临床病理因素.方法 选择1990年10月-2010年10月间北京大学人民医院收治的临床病理资料完整并完成随方的初治Ⅰ~Ⅱ期子宫内膜癌患者398例,回顾性分析影响患者复发及预后的临床病理因素.结果 398例Ⅰ~Ⅱ期子宫内膜癌患者中,复发36例,复发率为9.0%(36/398),其中58.3%(21/36)的患者在5年内出现复发.Ⅰ~Ⅱ期子宫内膜癌患者的复发率,年龄≤50岁[1.9% (2/103)]低于>50岁者[11.5%(34/295),P=0.004],子宫内膜样腺癌[8.0%(27/338)]低于浆液性腺癌[6/14,P=0.000],病理分级为G3者[17.9%(10/56)]高于G1~ G2[7.4%(25/338),P=0.022],肌层浸润深度≥1/2者[16.2%(16/99)]高于无肌层浸润[3.4%(2/59)]、肌层浸润深度<1/2者[7.5%(18/240),P=0.011],肿瘤长径>2 cm者[17.1% (19/111)]高于≤2 cm者[5.9%(17/287),P=0.000],腹水细胞学检查阳性者[23.8% (5/21)]高于阴性者[6.9% (22/317),P=0.019],ER阴性者[20.8%(11/53)]高于阳性者[5.5%(16/293),P=0.000],PR阴性者[30.0%(15/50)]高于阳性者[4.1%(12/295),P=0.031],以上各指标分别比较,差异均有统计学意义;而手术病理分期、淋巴脉管癌栓、术前血清CA125水平及p53、PTEN蛋白表达与患者复发无关(P>0.05).单因素生存分析显示,患者年龄、病理类型、病理分级、肌层浸润深度、肿瘤长径、腹水细胞学检查、PR表达对患者无瘤生存率(DFS)及总生存率(OS)均有显著影响(P<0.05);而ER表达仅对患者DFS有显著影响(P<0.05).结论 Ⅰ~Ⅱ期子宫内膜癌患者的复发及预后与年龄、病理分级、病理类型、肌层浸润深度、肿瘤长径、腹水细胞学检查结果及ER、PR表达有关.Ⅰ~Ⅱ期子宫内膜癌患者5年内复发率较高,因此在初治后5年内密切随访是必要的.
目的 探討影響Ⅰ~Ⅱ期子宮內膜癌患者複髮及預後的臨床病理因素.方法 選擇1990年10月-2010年10月間北京大學人民醫院收治的臨床病理資料完整併完成隨方的初治Ⅰ~Ⅱ期子宮內膜癌患者398例,迴顧性分析影響患者複髮及預後的臨床病理因素.結果 398例Ⅰ~Ⅱ期子宮內膜癌患者中,複髮36例,複髮率為9.0%(36/398),其中58.3%(21/36)的患者在5年內齣現複髮.Ⅰ~Ⅱ期子宮內膜癌患者的複髮率,年齡≤50歲[1.9% (2/103)]低于>50歲者[11.5%(34/295),P=0.004],子宮內膜樣腺癌[8.0%(27/338)]低于漿液性腺癌[6/14,P=0.000],病理分級為G3者[17.9%(10/56)]高于G1~ G2[7.4%(25/338),P=0.022],肌層浸潤深度≥1/2者[16.2%(16/99)]高于無肌層浸潤[3.4%(2/59)]、肌層浸潤深度<1/2者[7.5%(18/240),P=0.011],腫瘤長徑>2 cm者[17.1% (19/111)]高于≤2 cm者[5.9%(17/287),P=0.000],腹水細胞學檢查暘性者[23.8% (5/21)]高于陰性者[6.9% (22/317),P=0.019],ER陰性者[20.8%(11/53)]高于暘性者[5.5%(16/293),P=0.000],PR陰性者[30.0%(15/50)]高于暘性者[4.1%(12/295),P=0.031],以上各指標分彆比較,差異均有統計學意義;而手術病理分期、淋巴脈管癌栓、術前血清CA125水平及p53、PTEN蛋白錶達與患者複髮無關(P>0.05).單因素生存分析顯示,患者年齡、病理類型、病理分級、肌層浸潤深度、腫瘤長徑、腹水細胞學檢查、PR錶達對患者無瘤生存率(DFS)及總生存率(OS)均有顯著影響(P<0.05);而ER錶達僅對患者DFS有顯著影響(P<0.05).結論 Ⅰ~Ⅱ期子宮內膜癌患者的複髮及預後與年齡、病理分級、病理類型、肌層浸潤深度、腫瘤長徑、腹水細胞學檢查結果及ER、PR錶達有關.Ⅰ~Ⅱ期子宮內膜癌患者5年內複髮率較高,因此在初治後5年內密切隨訪是必要的.
목적 탐토영향Ⅰ~Ⅱ기자궁내막암환자복발급예후적림상병리인소.방법 선택1990년10월-2010년10월간북경대학인민의원수치적림상병리자료완정병완성수방적초치Ⅰ~Ⅱ기자궁내막암환자398례,회고성분석영향환자복발급예후적림상병리인소.결과 398례Ⅰ~Ⅱ기자궁내막암환자중,복발36례,복발솔위9.0%(36/398),기중58.3%(21/36)적환자재5년내출현복발.Ⅰ~Ⅱ기자궁내막암환자적복발솔,년령≤50세[1.9% (2/103)]저우>50세자[11.5%(34/295),P=0.004],자궁내막양선암[8.0%(27/338)]저우장액성선암[6/14,P=0.000],병리분급위G3자[17.9%(10/56)]고우G1~ G2[7.4%(25/338),P=0.022],기층침윤심도≥1/2자[16.2%(16/99)]고우무기층침윤[3.4%(2/59)]、기층침윤심도<1/2자[7.5%(18/240),P=0.011],종류장경>2 cm자[17.1% (19/111)]고우≤2 cm자[5.9%(17/287),P=0.000],복수세포학검사양성자[23.8% (5/21)]고우음성자[6.9% (22/317),P=0.019],ER음성자[20.8%(11/53)]고우양성자[5.5%(16/293),P=0.000],PR음성자[30.0%(15/50)]고우양성자[4.1%(12/295),P=0.031],이상각지표분별비교,차이균유통계학의의;이수술병리분기、림파맥관암전、술전혈청CA125수평급p53、PTEN단백표체여환자복발무관(P>0.05).단인소생존분석현시,환자년령、병리류형、병리분급、기층침윤심도、종류장경、복수세포학검사、PR표체대환자무류생존솔(DFS)급총생존솔(OS)균유현저영향(P<0.05);이ER표체부대환자DFS유현저영향(P<0.05).결론 Ⅰ~Ⅱ기자궁내막암환자적복발급예후여년령、병리분급、병리류형、기층침윤심도、종류장경、복수세포학검사결과급ER、PR표체유관.Ⅰ~Ⅱ기자궁내막암환자5년내복발솔교고,인차재초치후5년내밀절수방시필요적.
Objective To explore the high-risk clinicopathological features for the recurrence and prognosis of endometrial carcinoma diagnosed as International Federation of Gynecology and Obstetrics (FIGO) stages Ⅰ and Ⅱ.Methods Three hundreds ninety-eight consecutive patients with clinical stage I,Ⅱ endometrial adenocarcinoma underwent primary surgical therapy between Oct.1990 to Oct.2010 were studied retrospectively to analyze the correlation between clinicopathological risk factors and the disease recurrence or prognosis.Results Thirty-six patients (9.0%,36/398) developed recurrence,21 of them (58.3%,21/36) relapsed within 5 years of treatment.The results shown that the disease recurrence were significantly associated with clinicopathological factors including:age [≤50 years versus > 50 years,1.9% (2/103) versus 11.5% (34/295) ; P =0.004] ; histologic types [adenocarcinoma versus serous papillary adenocarcinoma,8.0% (27/338) versus 6/14; P =0.000] ; tumor grade [grade 1,2 (7.4%,25/338) versus grade 3 (17.9%,10/56) ;P =0.022] ; depth of myometrial invasion [none (3.4%,2/59) versus < 1/2 (7.5 %,18/240) versus ≥ 1/2 (16.2%,16/99) ; P =0.011] ; tumor size [≤ 2 cm (5.9%,17/287) versus > 2 cm (17.1%,19/111) ; P =0.000].peritoneal cytology [negative (6.9%,22/317) versus positive (23.8%,5/21) ;P =0.019] ;ER status[negative (20.8%,11/53) versus positive (5.5%,16/293) ; P =0.000] ; PR status [negative (30.0%,15/50) versus positive (4.1%,12/295) ; P =0.031].But lympho vascular space invasion (LVSI),p53 or PTEN status were not significant effect on recurrence and prognosis.Univariate analysis of survival indicated that age,histology,tumor grade,depth of myometrial invasion,tumor size,peritoneal cytology and PR status were correlated with overall survival(OS) and disease free survival (DFS ; all P < 0.05),while ER status only impact on DFS (P < 0.05).Conclusions The results showed that age,histologic type of carcinoma,myometrial invasion,tumor grade,peritoneal cytology,tumor size,ER and PR status are significant predictors for recurrence and prognosis of FIGO Ⅰ,Ⅱ stage endometrial carcinoma.Regular follow-up after treatment is essential for patients within 5 years.