20例早发型子宫内膜癌的临床特点分析

目的：探讨40岁以下子宫内膜癌患者的临床及病理特征。方法：对2004年12月—2012年12月收治的子宫内膜癌病例进行回顾性分析，其中≤40岁的患者（早发组）20例（占4%，20/498），＞40岁的患者（普通组）478例，比较2组患者的多项临床指标，分析患者的临床特征、高危因素、治疗方法、病理类型、组织学分级、肌层浸润深度、淋巴结转移与附件转移的关系。结果：早发组原发不孕发病率为30.0%（6/20），普通组为4.2%（20/478），差异有统计学意义（χ2=25.855，P=0.000）。普通组合并高血压率高于早发组（χ2=7.954，P=0.003）。早发组患者病理类型均为子宫内膜样腺癌，普通组子宫内膜样腺癌78.5%（375/478），2组患者病理类型差异有统计学意义（χ2=5.433，P=0.020）。早发组、普通组患者细胞分化为G1者分别占90%和49.8%。早发组、普通组临床病理Ⅰ期者分别占80%和74.1%，2组患者细胞分化程度及临床病理分期差异有统计学意义（Z分别为－8.259和－9.488，均P=0.000）。2组患者肌层浸润、宫颈累及、淋巴结转移、附件累及和腹水细胞学检查比较差异均无统计学意义（均P＞0.05）。结论：在子宫内膜癌患者中年轻妇女有着一定的比例，不孕不育是40岁以下子宫内膜癌患者的高危因素，年轻子宫内膜癌患者以子宫内膜样腺癌为主，细胞分化级别高，手术病理期别较早，深肌层浸润、淋巴结转移以及附件转移等情况与年长者相似。

The Clinical Characteristics Analysis of 20 Cases with Early Onset Endometrial Carcinoma

Objective：To study clinical characteristics of patients with endometrial carcinoma under 40 years old. Methods：To study endometrial carcinoma cases who were treated from December 2004 to December 2012 retrospectively. Those patients were divided into two groups，which were 20 cases（4%，20/498） at age of less than 40 years in early onset group and 478 cases with more than 40 years age in general group. Clinical characteristics，risk factors，treatment，pathological type，histological grading，myometrial invasion，lymph node metastasis and adnexal metastasis between two groups were reviewed and compared. Results：The percentage of primary infertility patient in early onset group was 30.0%（6/20），The percentage of normal group was 4.2%（20/478）. The difference was statistically significant（χ2=25.855，P=0.000）. The incidence of hypertension in early onset group is lower than the normal group（χ2=7.954，P=0.003）. All early onset group patients were endometrioid adenocarcinoma. The percentage of endometrioid adenocarcinoma in normal group was 78.5%（375/478），the difference was statistically significant between two groups（χ2=5.433，P=0.020），90% early onset group patients were histological grade G1，49.8% normal group patients were histological grade G1，the percentage of stage Ⅰ in early onset group was 80%，the percentage of stage I in normal group was 74.1%，the difference between histological grade （Z=-8.259，P=0.000） and clinical stage （Z=-9.488，P=0.000） was statistically significant. There were no statistical significance between two groups in deep myometrial invasion, cervical invasion and lymph node metastasis，adnexal metastasis and positive abdominal dropsy cytology （P＞0.05）. Conclusions：Young women occupy a certain proportion of endometrial cancer，infertility is a high risk factor for endometrial cancer whose age is under 40 years，major pathological type is endometrioid adenocarcinoma，histological grade tend to be G1，young patients tend to be diagnosed at an early stage，deep myometrial invasion，cervical invasion and lymph node metastasis，adnexal metastasis and positive abdominal dropsy cytology are similar to the elderly patients，etc.