子宫内膜癌治疗现状与进展

早期子宫内膜癌的治疗以手术为主,晚期癌则采取手术、放疗、化疗的综合疗法.早期病例的手术方式并不一致,晚期癌手术与放疗如何合理配合仍有争论,化疗的应用也存在不同意见.     

钙调蛋白结合蛋白在子宫平滑肌肿瘤诊断中的意义

目的　探讨高度敏感和特异的诊断子宫平滑肌肿瘤的指标。方法　选取子宫内膜间质肉瘤 2 6例 ,子宫普通型和富于细胞性平滑肌瘤各 2 5例 ,子宫平滑肌肉瘤 17例 ,正常子宫肌层和正常子宫内膜各 2 5例 ,采用免疫组化 S-P法检测各种组织中结蛋白、平滑肌肌动蛋白、雌激素受体以及重型钙调蛋白结合蛋白 (h-caldesmon)的表达。结果　正常的子宫肌层、子宫普通型平滑肌瘤、富于细胞性平滑肌瘤和子宫平滑肌肉瘤中重型钙调蛋白结合蛋白的表达分别为 10 0 .0 %、10 0 .0 %、96.0 %和 64.7% ,但正常子宫内膜和子宫内膜间质肉瘤细胞中均未见其表达。重型钙调蛋白结合蛋白诊断富于细胞性平滑肌瘤不仅敏感度高于结蛋白 ,而且特异度达 10 0 .0 %。结论　重型钙调蛋白结合蛋白可辅助正确鉴别子宫富于细胞性平滑肌瘤和子宫内膜间质肉瘤     

Prognostic importance of the nuclear proteins p53 and Rb in conjunction with DNA, nuclear morphometry and grading in endometrial carcinoma

In a series of 227 cases of endometrial carcinomas in FIGO stages I–IV, treated during the years 1984–89, immunohistochemical staining for the protein products of the two tumor suppressor genes p53 and retinoblastoma (Rb) were evaluated as prognostic factors with regard to tumor stage, FIGO grade, nuclear grade, morphometric nuclear parameters, DNA ploidy and S-phase fraction. Long-term survival analyses were endpoints and the Cox multivariate technique was used to evaluate the prognostic factors. In 20% of the cases p53 was positive. This was a genuine high-risk group associated with primary advanced carcinoma, nonendometrioid histology, poorly differentiated tumors, severe nuclear atypia, DNA aneuploidy, primary persistent tumors, recurrent tumors and a poor long-term survival rate (37% 5-year survival). In patients dying of their disease, 54% of the tumors stained positive for p53, compared with only 10% of the tumors not killing their hosts. Positive p53 staining was more common in older women. A pathologic Rb status (negative staining) was recorded in 6% of the cases. The Rb factor had only a minor influence on long-term survival and was not significant in multivariate analyses. The p53 staining status was the second most important prognostic factor after the nuclear grade in Cox multivariate analyses, after correcting for stage and age. Immunohistochemical staining for p53 protein should be included among previous available and important prognostic factors in endometrial carcinoma.     

Peripheral progesterone (P) levels and endometrial response to various dosages of vaginally administered P in estrogen-primed women

Objective: To compare the pharmacokinetics and pharmacodynamics of 100 mg/d, 200 mg/d, and 400 mg/d (200 mg two times per day) of P administered vaginally for 14 days to estrogen-primed postmenopausal women.Design: Randomized, open-label, three-way crossover study.Setting: Two university-based investigative sites.Patient(s): Twenty healthy postmenopausal women with histologically normal endometria.Intervention(s): Oral 17,β-E₂ was given each day of a 28-day cycle; a P vaginal suppository was inserted daily according to the randomization schedule during days 15–28 of each cycle; blood samples were collected; an endometrial biopsy was obtained on day 25; and patients were crossed over to the next treatment cycle after a washout period of at least 30 days.Main Outcome Measure(s): Mean P blood levels, endometrial dating/conversion.Result(s): There was good vaginal absorption of P for all dosages. Endometrial conversion occurred in all 200- and 400-mg/d P-dosed cycles, whereas the 100-mg/d dosage failed to convert primed endometria consistently. There also was a significantly increased tendency for earlier bleeding and spotting with the 100-mg/d dosage.Conclusion(s): Both the 200- and 400-mg/d dosage regimens consistently convert an estrogen-primed endometrium, and yield appropriate endometrial dating and bleeding patterns. However, the 400-mg/d dosage attains the highest sustained blood levels and may be the best dosage regimen for further study.     

Dietary factors and cancers of breast, endometrium, and ovary: Strategies for modifying fat intake in African American women

Modification of dietary fat and fiber could help prevent cancers of the breast, endometrium, and ovary that are prevalent in African-American women. Dietary intervention programs aimed at reducing fat intake have had mixed results in this population. The transtheoretic model is proposed for achieving dietary change. Strategies for changing health behaviors in African-American women include heightening sensitivity to cultural values among health educators and the use of multiple strategies to reinforce messages. To stimulate healthier eating, it is important to incorporate the distinct habitual eating patterns into innovative intervention methods, using effective behavioral change methods. (Am J Obstet Gynecol 1997;176:S255-64.)     

Subcutaneous estradiol pellets for endometrial preparation in donor oocyte recipients with a poor endometrial response

Purpose: The purpose of this study was to evaluate the clinical effectiveness of subcutaneous estradiol pellets in donor oocyte recipients with an inadequate endometrial response. Methods: The subjects were 13 women with ovarian failure and a maximal endometrial thickness <10 mm on standard estrogen regimens, as demonstrated during mock and/or prior oocyte donation cycles. They underwent pellet implantation (100–250 mg of estradiol) 6–13 weeks before oocyte donation. Results: Maximal (mean ± SD) endometrial thickness was 8.7±1.5 mm on standard regimens, in contrast to 11.7± 1.8 mm on pellets, while estradiol levels were 674±844 and 815±706 pg/ml, respectively. The estradiol:estrone ratio on pellets was >1. There was 1 pregnancy with early loss during 10 cycles on other estrogen regimens and 12 pregnancies during 19 cycles on pellets. The pregnancy and implantation rates were, respectively, 63 and 27% on pellets and 41 and 14% on standard regimens in historical controls. Conclusions: We conclude that estradiol pellets after a single administration provide constant estradiol levels extending into the first trimester of pregnancy, a physiologic estradiol:estrone ratio, and a better endometrial response than standard estrogen regimens. Implantation and pregnancy rates are higher. This approach may be especially suitable for recipients with a poor endometrial response. Presented at the IXth World Congress on In Vitro Fertilization and Assisted Reproduction, Vienna, Austria, April 3, 1995, and the 51st Annual Meeting of the American Society for Reproductive Medicine, Seattle, Washington, October 7–12, 1995.     

An Analysis of Approaches to the Management of Endometrial Cancer in North America: A CTF Study

Objective.The aim of this study was to define the clinical–therapeutical approach to endometrial cancer now being followed in some of the most important centers of reference for gynecological cancer in North America by means of a questionnaire.Study design.The questionnaire focused on four principal areas: (1) surgical staging and therapy; (2) adjuvant treatment; (3) treatment modifications; and (4) management of advanced stages (FIGO III–IV).Results.There were 48 evaluable responses (77%) received by the end of December 1994 which were considered for this analysis. Lymphadenectomy is utilized routinely in 26/48 centers (54.2%) and in selective clinical–pathological conditions in another 21/48 centers (43.5%). In the majority of centers (31/48; 64.6%) radical surgery is utilized for selected indications such as cervical involvement. Only 3/48 (6.2%) centers consider the vaginal approach totally inappropriate. The great majority (40/48; 83.3%) of the centers considered postsurgical adjuvant therapy to be necessary in FIGO Stage Ic. Brachytherapy is routinely performed in 3 centers (6.2%) in postsurgical management of Stage I endometrial cancer, while the majority of the centers (31/48; 64.6%) perform brachytherapy of the vaginal vault in certain clinical–pathological conditions. A wide variety of treatments are used for advanced stages (FIGO III–IV).Conclusions.It emerges that some controversial aspects exist on endometrial cancer treatment, and these conflicting data need a large-scale multicenter randomized clinical trial.     

P16蛋白在子宫内膜癌的表达及与细胞增殖活性的关系

目的：探讨P16基因蛋白在子宫内膜癌发生中的作用。方法：采用免疫组化方法对42例子宫内膜癌中P16蛋白和增殖细胞核抗原（PCNA）的表达进行观察。结果：P16蛋白在子宫内膜癌的阳性率为69．1％（29／42），显著低于其在正常子宫内膜（100％，8／8）及子宫内膜不典型增生（90．9％，20／22）中的阳性率（P＜0．05）。等级相关分析显示，随肿瘤组织学分级的增加、临床分期的升高及肿瘤浸润深度的增加，P16蛋白阳性率逐渐降低（P＜0．01）。PCNA标记指数与肿瘤分化程度及临床分期有关，而与浸润无关。P16蛋白阳性者的PCNA指数低于P16蛋白阴性者（P＜0．05）。结论：P16基因蛋白参与子宫内膜癌的发生、发展，并与部分生物学行为有关。     

PTEN、p53在子宫内膜浆液性癌和宫内膜样癌中的表达及临床病理意义

目的研究PTEN和p53在子宫内膜浆液性癌和宫内膜癌中的表达及临床病理意义。方法应用免疫组化方法检测26例宫内膜浆液性癌、42例宫内膜样癌和25例正常增生期宫内膜组织中PTEN、p53蛋白的表达。结果PTEN和p53蛋白在子宫浆液性癌、宫内膜样癌、正常增生期内膜中的阳性表达率分别为86.4%、28.6%、100%和76.9%、27.3%、0%。PTEN在子宫内膜样癌中阳性表达率明显低于浆液性癌(P<0.001)。p53蛋白表达与子宫内膜癌组织学类型、临床分期、病理分级、肌层浸润等因素有关(P<0.05)。结论PTEN突变和表达缺失与宫内膜样癌的发生、发展有关。p53基因突变和过表达与宫内膜浆液性癌发生发展关系密切。PTEN及p53蛋白检测对鉴别子宫浆液性癌与宫内膜样癌有重要价值。     

Primary clinical analysis of medical disorders in Chinese women with endometrial carcinoma

The objectives of this study were to survey the prevalence of medical disorders in Chinese women with endometrial carcinoma and evaluate their potential impact on the clinical treatment and prognosis. Three hundred and seven women with endometrial carcinoma, from July 1, 1971 to October 31, 2001, were analyzed retrospectively. One hundred and forty-six of them (47.6%) were found to have associated medical disorders. The most common medical disorders were hypertension (33.9%), diabetes mellitus (9.8%), and coronary heart disease (9.4%). As many as 38.4% of the women had two or more medical disorders. The patients with medical disorders were on average elder than those without any medical disorders (P < 0.01). Radiotherapy and chemotherapy were administered more commonly in the group with medical disorders than in the one without (P < 0.01). The rate of surgical procedures was significantly lower in the group with medical disorders than in the group without (P < 0.01). However, the extent of surgical interventions was similar in both groups (P > 0.05). The occurrence of medical disorders was independent of the tumor stage, grade, and histological types (P > 0.05). In addition, follow-up data showed that the 3-year and 5-year survivals were not influenced by the medical disorders (P > 0.05). The results thus suggest that Chinese women with endometrial carcinoma have frequently concurrent medical disorders. Selection of treatment strategies can be influenced by these associated medical disorders, but the overall survival is little changed.