Ⅰ,Ⅱ期子宫内膜癌治疗方法的评价

目的：评价子宫内膜癌不同治疗方法的效果。方法：对１９８４～１９９２年间收住我院治疗的２０５例Ⅰ期及Ⅱ期子宫内膜癌的临床及病理资料进行回顾性分析。其中临床Ⅰ期１２２例、临床Ⅱ期８３例。按治疗方法不同分为４组：（１）手术组：首选治疗方法为手术者，８１例；（２）术前腔内全量放疗组，６２例。放疗Ｆ点剂量为５０Ｇｙ±１０％，Ａ点剂量为４５Ｇｙ±１０％；（３）术前腔内非全量放疗组，３６例。放疗Ａ点及Ｆ点剂量均＜１／２腔内全量放疗组；（４）单纯放疗组，２６例。４组间病理类型、组织分化程度、中位年龄及手术术式均无统计学差异。结果：４组患者的５年生存率依次为：Ⅰ期：８３．１％、９６．５％、８４．８％、６２．５％；Ⅱ期：８２．０％、９０．９％、５１．４％、６２．７％。术前腔内全量放疗组５年生存率明显为高（Ｐ＜０．０５）。结论：对Ⅰ、Ⅱ期子宫内膜癌，术前行全量腔内放疗是提高疗效的有效方法，术前行部分腔内放疗无明显作用。     

卵巢上皮性癌155例的治疗与预后

目的：探讨卵巢上皮性癌的治疗与影响预后的因素。方法：对１９７０年１月至１９９２年１２月在我院治疗的１５５例卵巢上皮性癌进行回顾性分析。全部手术切除标本经病理检查诊断并按ＦＩＧＯ分期标准进行分期，４２例行２次手术，４例行３次手术。除６例外，余１４９例均于手术后行化疗，３２例于第２次术后再次行化疗，９例因复发再次化疗。结果：２年、５年、１０年的生存率分别为Ⅰ期９２．４％、８７．０％、７０．６％；Ⅱ期９１．９％、６３．６％、４７．８％；Ⅲ期５９．９％、３８．２％、１９．２％；Ⅳ期２５．０％、２５．０％、０．０％（Ｐ＜０．００１）。６例未化疗者均在术后２年内死亡。结果表明，预后与临床分期、细胞分化、残留癌灶大小有关。５年生存率中，Ⅰ期为８７．０％和Ⅲ期为３８．２％（Ｐ＜０．００１）；Ｇ１的５年生存率为９５．９％，Ｇ３为１１．８％（Ｐ＜０．００１）；无残留癌灶者为９７．６％，残留癌灶＞２ｃｍ者为２１．２％（Ｐ＜０．００１）。结论：在卵巢上皮性癌初次手术时残留癌灶＜２ｃｍ，并于术后尽早开始化疗，可提高生存率。     

子宫颈癌551例诊治分析

目的：对子宫颈癌５５１例进行诊治分析，以提高子宫颈癌患者的早诊率，使患者早期得到治疗，从而提高患者的生存率和生存质量。方法：由上海市子宫颈癌专题协作组设计表格，由经过培训的专职妇科医师调查填表。将１９９１年新发病例与年龄范围上下相差２岁的同期、同地区妇女按１∶２的比例设对照组进行流行病学调查。结果：子宫颈癌５５１例平均发病年龄６４．７岁，＞５０岁５２４例、占９５．１％。多因素分析表明，经济条件差、丈夫吸烟有显著意义（Ｐ＜０．０５）。子宫颈癌Ⅰ期６２例、仅占１１．３％，＞Ⅱ期４８９例、占８８．７％。宫颈鳞癌４４８例、占８１．３％，腺癌５５例、占１０％，其它癌４８例、占８．７％，根据分析结果实施综合性防治措施，上海市普查中子宫颈癌的诊断率从４．３％提高到１９％，早诊率从１０．６％上升到２８．６％。结论：采取综合措施可提高子宫颈癌早诊率，执行《中国常见恶性肿瘤治疗规范》可提高子宫颈癌患者的生存率和生存质量。     

子宫颈癌卵巢转移17例分析

目的：分析宫颈癌特别是早期宫颈癌卵巢转移的危险性。方法：回顾性分析１９５８年至１９９４年我院收治的１７例宫颈癌卵巢转移的情况。结果：１７例患者中，１０例为肉眼可见转移，７例为病理检查证实。１１例（５８．８％）转移至双侧卵巢，１３例同时累及宫体、盆腔及主动脉旁淋巴结。１７例患者中，１０例为宫颈鳞癌卵巢转移，７例为宫颈腺癌卵巢转移，转移率分别为０．０７％和１．８１％，差异有显著性（Ｐ＜０．０５）。１７例患者中，宫颈癌Ⅰ、Ⅱ期者为８例，宫颈鳞癌无Ⅰ期患者，Ⅱ期卵巢转移率为０．０８％；宫颈腺癌Ⅰ期卵巢转移率为９．５％，Ⅱ期为１．２％。手术治疗的Ⅰ、Ⅱ期患者中，宫颈腺癌的卵巢转移率为７．８％，Ⅱ期宫颈鳞癌患者的卵巢转移率为１．６％。１７例患者的预后差，５年生存率为１７．６％。结论：宫颈腺癌早期有发生卵巢转移的危险性。宫颈癌患者是否保留卵巢的问题，值得进一步探讨。     

对恶性卵巢肿瘤手术治疗几个问题的商榷（附86例临床分析）

为探讨卵巢癌合理的手术治疗方案，分析了８６例手术治疗的临床资料，将卵巢恶性肿瘤的手术范围和方式归纳为四类，并强调术后辅助腹腔化疗。术后随访满３年者３１例，满５年者１１例，其中Ⅰ～Ⅱ期３年生存率为８０％（８／１０），术后满５年的３例均存活；Ⅲ期３年生存率为５７．１％（１２／２１），５年生存率２５％（２／８）。作者认为（１）肿瘤细胞减灭术是治疗晚期卵巢癌的首选方法和主要手段，应尽可能地切除原发肿瘤及所能看到的盆腹腔内转移癌灶。但对个别病例要注意掌握适应证；（２）对早期病例应常规施行腹膜后淋巴［盆腔淋巴及（或）腹主动脉旁淋巴］清除；对晚期病例应在手术基本切除干净（残留癌灶≤２ｃｍ）的情况下，积极施行淋巴清除术，以提高生存率；（３）在细胞减灭术中，必须认真对待肠转移癌的处理。     

59例Ⅰ期子宫内膜癌的治疗分析

为探讨Ⅰ期子宫内膜癌更为合理的治疗方案，方法将５９例Ⅰ期子宫内膜癌患者随机分为两组：第１组３０例，单纯全子宫，双附件切除加辅助治疗；第２组２９例，行全子宫，双附件切除加盆腔淋续清扫或活检。结果第１组中死亡２例，２年和５年的存活率均为９６．６％平均生存６９．７个月。第２组中死亡３例。     

490例子宫颈癌腔内后装放射治疗疗效观察

本研究回顾性总结了１９８６年至１９８７年期间，我院采用＾１３７Ｃｓ腔内后装治疗子宫颈癌４９０例的治疗结果。其中，Ⅰｂ期１０例，Ⅱｂ期３６６例，Ⅲｂ期１１４例。５年绝对生存率分别为Ⅰｂ期９０．０％，Ⅱｂ期６６．１％，Ⅲｂ期５６．１％。治疗结果的分析表明，＾１３７Ｃｓ腔内后装放射治疗的合适剂量为５５Ｇｙ，每周治疗１次，每次６～７Ｇｙ。本研究结果提示，中剂量率腔内后装治疗的效果与低剂量率腔内镭疗的治疗效     

子宫颈转移癌19例临床分析

目的：分析子宫颈转移癌的临床特点及治疗情况。方法：回顾性分析我院１９５９年至１９９４年收治的１９例子宫颈转移癌病例。结果：１９例子宫颈转移癌患者的平均年龄为４３．７岁。主要症状为阴道排液和（或）阴道不规则出血（占６８．４％）；原发瘤多为消化道肿瘤及卵巢癌。治疗方法包括单纯放疗、手术后放疗及化疗、手术后放疗。根据寿命表法计算，１年、２年及５年生存率分别为６８．５％，４７．３％及２６．２％，存活最长１例已达２２年。结论：如原发灶肿瘤获得满意治疗，转移瘤仅局限于宫颈并对放疗敏感者，可获得较好的疗效     

股动脉插管灌注大剂量DDP治疗卵巢癌24例分析

我院采用经皮股动脉插管双髂内动脉灌注大剂量ＤＤＰ（简称动注法）治疗卵巢癌２４例，其中显效１２例，有效１０例，稳定１例，恶化１例，近期有效率为９１．７％，２年及３年生存率分别为７０．８％及５４．１％，无肾功能损害和耳毒性反应的发生，显示动注法可达到高效低毒的效果，是较满意的化疗方法。     

子宫内膜癌Ⅳb期临床特征和预后分析

目的：分析Ⅳｂ期子宫内膜癌的临床特征,探讨与其预后的相关因素。方法：回顾性分析Ⅳｂ期子宫内膜癌的临床病理特征及随访结果。结果： １１例子宫内膜癌Ⅳｂ期患者,平均 ６１． １岁,绝经 ９例,平均绝经 １４．９年。临床症状主要是绝经后阴道不规则出血或血性分泌物（９／１１）,其次为腹胀（４／１１）、腹部包块（３／１１）,出现症状至就诊平均 １５．１个月。 １０例手术治疗, １例拒绝手术,仅行内分泌治疗,８例行术中、术后化疗,３例术后放疗;平均随访 １２．９个月,死亡 ６例,２年生存率 ２８％,３年生存率 １４％。盆腹腔复发 ３例均死亡,平均存活 ６．７个月,发生肺转移５例,３例死亡,平均存活１４．７个月。术后残存病灶＞２ｃｍ ４例,均因复发转移死亡,平均存活９个月,术后无残存病灶３例均存活。结论：Ⅳｂ期子宫内膜癌患者年龄较大,就诊较晚,多表现为绝经后不规则阴道出血,治疗以手术为主,尽可能切除所有病灶,并辅助放化疗,但预后较差,其相关因素主要有首次手术的彻底性,宫旁血管淋巴管受侵,病灶范围及复发转移部位等。     

生殖系统原发性恶性黑色素瘤42例临床分析

目的探讨生殖系统原发性恶性黑色素瘤的诊断、治疗及预后影响因素。方法对42例生殖系统原发性恶性黑色素瘤患者的临床和病理资料进行回顾性分析。结果42例患者中,原发于外阴、阴道及宫颈的恶性黑色素瘤患者分别为14例（33％）、23例（55％）及5例（12％）。其中,38例手术治疗前行肿瘤组织活检,6例误诊,术前误诊率为16％;18例术后行免疫组化S-100蛋白检测,18例（100％）均阳性;16例术后行抗黑色素瘤特异性抗体（HMB-45）检测,14例（88％）阳性。本组患者的2年、5年累积无瘤生存率分别为35％及23％,2年、5年累积总生存率分别为53％及27％。按国际妇产科联盟（FIGO,2000年）的分期标准,Ⅰ、Ⅱ期（早期）和Ⅲ、Ⅳ期（晚期）患者的2年累积总生存率分别为77％及34％,两者比较,差异有统计学意义（P〈0．05）;Ⅰ、Ⅱ期患者的2年累积总生存率分别为78％及74％,两者比较,差异无统计学意义（P=0．303）。对40例接受手术治疗患者的临床资料进行单因素分析显示,术后辅助化疗对患者的累积无瘤生存率和累积总生存率有明显影响（P〈0．05）;广泛性手术、区域淋巴结切除、生物治疗对预后则无明显影响（P〉0．05）。化疗联合生物治疗和单纯化疗患者的2年累积无瘤生存率分别为49％及34％,两者比较,差异无统计学意义（P〉0．05）。结论生殖系统原发性恶性黑色素瘤术前活检的误诊率高,应用免疫组化染色检测可提高诊断的准确性。FIGO分期难以准确评价早期患者的预后。手术是主要治疗手段,术后辅助化疗可显著改善患者的预后。     

Ovarian cancer incidence and survival in Korea: 1993–2002

This study examined incidence rates, histologic and stage distribution, and long-term survival rates of patients with ovarian cancer in Korea. A total of 11,404 patients diagnosed with ovarian cancer between 1993 and 2002 were reported to the Korea Central Cancer Registry and the Gynecologic Oncology Committee of Korean Society of Obstetrics and Gynecology. All rates were expressed per 100,000. The age-standardized incidence rates were 3.79 and 4.74 per 100,000 women in 1993 and 2002, respectively. The incidence rates of ovary cancer increased with age in Korea, and over half of the patients were in the stage IA (24.8%) and IIIC (26.8%) in this study. The 5-year relative survival rate was 59.6%. Relative survivals according to the stage of FIGO at 5 years were 91.1%, 75.2%, 46.4%, and 21.2% for stages I, II, III, and IV, respectively. The 5-year relative survivals of germ cell tumors and epithelial ovarian cancer were 89.0% and 58.3%, respectively. Surgical stage and histology were the most important prognostic factors of ovarian cancer. However, the 5-year survival rate of FIGO stage IC was significantly higher than that of stage IB.     

外阴癌39例手术治疗及预后分析

目的 总结我院治疗外阴癌的手术方式,分析与外阴癌预后有关的因素。方法 回顾性分析我院１９７９－１９９７年收治的３９例侵袭性外阴癌的临床资料。其中外阴病灶局部切除术５例、部分外阴根治术１３例及全外阴根治术２１例。应用ＳＰＳＳ地不同的手术方式秀关预后因素进行比较分析。结果 ３９例中鳞癌３３例,占８４．６％,其中高、中、低分化分别为２６、５、２例。临床分期为Ⅰ期７例（１７．９％）Ⅱ期１７例（４３．６％）     

Radical hysterectomy with pelvic lymph node dissection for treatment of cervical cancer: a clinical review of 954 cases

Nine hundred fifty-four patients, who received a radical hysterectomy and a bilateral pelvic lymphadenectomy, were included in this study which ran from January 1971 to December 1986. The subjects, by in large, ranged in age from 41 to 60. Of these cases, 62.5% were in clinical stage IB, while 26.2% were in stage IIA. Urinary tract fistula formations occurred in 2.4% of the cases and substantially decreased from 6.1% during 1971-1978 to 0.9% in the subsequent period from 1979 to 1986. The operative mortality rate was 0.4%. The follow-up included 438 cases that came from 1971 to 1981, and each was evaluated over a period of 5 years. Of these cases, 28 patients were lost during the follow-up period and were presumed to have died from cancer. The absolute 5-year survival rates for the patients in stage IB, stage IIA, and IIB were 86.1, 71.7, and 60.1%, respectively. The respective 5-year survival rates for patients with stage IB LN(-) and LN(+), i.e., without or with lymph node metastasis, were 87.7 and 73.1%. The survival rates for patients with stage IIA LN(-) and LN(+) were 79.8 and 40.9%, respectively. In retrospect, the 5-year survival rates seem to be related to age, parametrial involvement, and histological type. This study shows that because of improving surgical techniques and anesthesia, acceptable operative morbidity and mortality, as well as favorable 5-year survival rates, radical surgery seems to be the treatment of choice for patients with early invasive uterine cervical, and especially for younger women.     

Unique prognostic features of grade 3 endometrioid endometrial carcinoma: Findings from 101 consecutive cases at a Japanese tertiary cancer center

ObjectiveThe prognosis of and optimal treatment for grade 3 endometrioid endometrial carcinoma (G3EEC) currently remain unclear. This study aimed to clarify the baseline recurrence risk in patients with early-stage (stage I–II) G3EEC without adjuvant therapy and the prognosis of patients with advanced-stage (stage III–IV) G3EEC.Materials and methodsA total of 101 patients with pathologically confirmed G3EEC from 1997 to 2018 were identified. Their clinicopathological characteristics and survival outcomes were reviewed retrospectively. Disease-free survival and overall survival values were estimated according to the Kaplan–Meier method and compared using a log-rank test.ResultsRecurrence was observed in eight (13%) of 63 patients with early-stage G3EEC, none of whom had received adjuvant therapy. The 5-year disease-free survival and 5-year overall survival rates for these patients were 86.7% and 96.4%, respectively. Recurrence was also observed in 12 (41%) of 29 patients with stage III G3EEC. The 5-year overall survival rates for stage III patients who underwent adjuvant chemotherapy and adjuvant radiotherapy were 85.6% and 42.9%, respectively. The 3-year overall survival rate among stage IVB patients was only 12.7% despite multidisciplinary treatment provision.ConclusionOur study newly demonstrates that patients with early-stage G3EEC have a favorable prognosis and a low recurrence rate in the absence of adjuvant therapy. In patients with stage III G3EEC, adjuvant chemotherapy was more beneficial than adjuvant radiotherapy. The poor prognosis of patients with stage IV G3EEC indicates the need for more effective treatments. Unique therapeutic approaches based on staging are recommended for treatment of G3EEC.     

Long-term follow-up of patients with advanced ovarian cancers treated with intermittent administration of combination chemotherapy with cisplatin, doxorubicin and cyclophosphamide

Despite high primary response rates with cisplatin-based combination chemotherapy, the overall survival rate for advanced ovarian cancers remains dismal. We designed a new systematic treatment approach with a combination chemotherapy consisting of cisplatin, doxorubicin and cyclophosphamide (cyclic PAC chemotherapy), with the aim of improving survival rates with minimal disturbance of quality of life. Cyclic PAC chemotherapy is a three-step chemotherapy with three courses of the PAC regimen in each step. A total of nine courses with a 3-month drug-free period between each step were administered over a 15-month period to patients with clinical stage IC-IV ovarian cancer who had undergone cytoreductive surgery. Forty-eight patients with stage IC-IV disease (34 patients with stage III and IV disease) were treated with cyclic PAC chemotherapy. Thirty-four patients with stage IC-IV disease (23 patients with stage III and IV disease) were treated by a brief course of PAC chemotherapy. Long-term survival and toxicity were evaluated for both treatment groups. Cyclic PAC chemotherapy improved the overall outcome of patients (66.6% 3-year and 56.5% 5-year survival rates) compared to brief PAC (41.2% 3-year and 23.5% 5-year survival rates) ( P < 0.01). The outcome of patients with stage III-IV ovarian cancer of the cyclic PAC group (52.6% 3-year and 37.2% 5-year survival rates) was also superior to that of the brief PAC group (21.7% 3-year and 8.7% 5-year survival rates). Generally, the treatment was well tolerated. The toxicity was similar in both groups, although myelosuppresion and neurotoxicity were rather prominent in the cyclic PAC group. Cyclic PAC chemotherapy may lead to improved survival in advanced ovarian cancer, and merits further investigation in a randomized study.     

Survival and prognostic factors of women with advanced ovarian cancer and complete response after a carboplatin-paclitaxel chemotherapy

OBJECTIVE: We evaluated the characteristics and determinants of 5-year survival in ovarian cancer patients with complete response after first line treatment who entered a randomised study comparing two different chemotherapeutic schedules. METHODS: This analysis included 232 ovarian cancer patients with complete response after first line surgery and chemotherapy coming from a large randomised trial comparing the effect of different doses of paclitaxel combined with fixed doses of carboplatin. RESULTS: The 5-year overall survival in patients was 57.3%. The difference in 5-year survival for age <52 years (65.1%), 53-62 (51.4%) and > or = 63 (51.2%) was statistically significant (P = 0.048). The 5-year overall survival rates were 64.6% for stage III and 57.9% for stage IV. Serous and clear cell histotypes had a worse 5-year overall survival (51.5% and 50.8% respectively), while the endometrioid and mucinous had 67.1% and 71.4%: these differences were statistically different (P = 0.04). Women with residual tumour of 1 cm or smaller after primary surgery had better 5-year survival rates: 71.2% for patients with residual tumour < or = 1 cm and 46.9% for residual tumour >1 cm: these differences were statistically significant (P < 0.006). CONCLUSION: This study shows that in women with ovarian cancer and complete response after first line surgery and chemotherapy, age, histotype and residual tumour after surgery are determinants of 5-year overall survival.     

52例原发性阴道癌临床分析

Objective?To investigate the clinical features and prognostic factors of primary vaginal cancer. Methods?A total of 52 patients with complete pathological diagnosis and clinical follow-up data were selected from the first Affiliated Hospital of Zhengzhou University from January 2013 to January 2020. The general characteristics, different treatment methods and overall prognosis of the patients were analyzed. Results?the 1-year, 3-year and 5-year survival rates of 52 patients with primary vaginal cancer were 80.7%, 61.1%, and 48.1%, respectively. Among them, 28 patients (53.8%) had squamous cell carcinoma, and the median survival time was 92 months. There were 12 cases of malignant melanoma (23.0%), and the median survival time was 12 months The 5-year survival rates of early stage (stageⅠ+stageⅡ) and late stage (stageⅢ+stageⅣ) were 61.0% and 0.0%, respectively. Univariate analysis showed that FIGO stage, pathological type, tumor size, treatment mode, tumor growth stage and vaginal invasion length were related to the prognosis of patients (P<0.05). COX multivariate regression analysis showed that 2009 FIGO stage (P=0.002) and pathological type (P=0.000) were independent factors affecting the prognosis of patients with primary vaginal cancer.  The prognosis of different pathological types, such as squamous cell carcinoma and malignant melanoma, was significantly different (χ2=17.704, P=0.000). There was statistically significant difference between combined radiotherapy and chemotherapy with radiotherapy or chemotherapy alone (χ2= 4.017, P=0.045). Conclusion?The prognosis of primary vaginal cancer is related to pathological type and clinical stage. The earlier the clinical stage, the better the prognosis. The survival cycle of squamous cell carcinoma is much higher than that of malignant melanoma. The treatment is mainly radiotherapy, and the combined treatment of radiotherapy and chemotherapy is better than radiotherapy or chemotherapy alon.     

Endometrioid carcinoma of the ovary: clinicopathologic analysis in 87 cases

From Jan. 1972 through Dec. 1984, 87 cases of endometrioid carcinoma of ovary were treated in our hospital, accounting for 23.5% of all cases of epithelial ovarian cancer admitted during the same period. Histologically they could be subdivided into 4 types, i. e. endometrioid carcinoma, clear cell carcinoma, adenocanthoma, and adenosquamous carcinoma. The 5-year survival rates for each type of tumors were 51.2, 0, 100 and 0% respectively. The 5- and 10-year survival rates were 90.1 and 90.1% for stage I, patients, 23.3 and 23.3% for stage II, 4.6 and 0% for stage III, and nil for stage IV. For improving the survival rate and reducing the incidence of recurrence, postoperative long term hormonal therapy should be considered.     

Ⅰ期子宫内膜癌不同术式疗效的研究

目的　对Ⅰ期子宫内膜癌不同术式的疗效及其术后并发症进行比较分析。方法　回顾性分析 1986年 1月至 1997年 12月手术治疗的 2 11例Ⅰ期子宫内膜癌 ,根据术式不同分为两组 ,61例采用全子宫加双侧附件切除术 (组 1) ,150例采用广泛性全子宫切除术 (组 2 )。对两组的疗效及术后并发症进行比较分析。结果　组 1和组 2总的 5年生存率分别为 96 0 %、93 5% ,两组比较 ,差异无显著性 (P >0 0 5) ;复发率分别为 6 6%、10 7% ,两组比较 ,差异无显著性 (P >0 0 5) ;术后并发症分别为 11 5%、2 4 7% ,两组比较 ,差异有显著性 (P <0 0 5)。结论　Ⅰ期子宫内膜癌患者可以采用全子宫加双侧附件切除术