358例子宫内膜癌手术方式及影响预后的危险因素分析

目的:探讨子宫内膜癌的手术方式及影响预后的危险因素。方法:回顾性分析资料完整、初治为手术治疗并经病理学诊断确诊,且进行系统分期手术的358例子宫内膜癌患者的临床情况及手术方式,并进行随访。对可能影响子宫内膜癌患者预后的危险因素进行分析。结果:358例患者中位发病年龄52岁(20~78岁),3年总体无瘤生存率分别为Ⅰ期97.12%,Ⅱ期91.67%;Ⅲ期85.19%,复发及死亡14例。开腹手术326例(91.06%),腹腔镜手术32例(8.94%)。与开腹组手术患者比较,腹腔镜组手术时间较长、平均估计术中失血量较少且平均住院时间短,差异有统计学意义(P0.05)。单因素分析表明,有内科合并症、手术病理分期晚、仅行盆腔淋巴结取样、脉管癌栓阳性、盆腔和(或)腹主动脉旁淋巴结转移是影响子宫内膜癌患者预后的危险因素;多因素分析表明,盆腔淋巴结转移是影响子宫内膜癌患者预后的独立危险因素(P=0.000,OR=11.901,95%CI3.291~43.039)。结论:子宫内膜癌以开腹手术为主,腹腔镜手术显示了微创的优势。手术病理分期晚期、伴有内科合并症、仅行盆腔淋巴结取样术、脉管癌栓阳性、腹主动脉旁淋巴结转移,特别是有盆腔淋巴结转移的子宫内膜癌患者预后差。     

Ⅰ～Ⅲ期子宫内膜癌淋巴结转移及预后的相关因素分析

目的:探讨国际妇产科联盟(FIGO)Ⅰ～Ⅲ期子宫内膜癌患者的临床病理特征与淋巴结转移及预后的相关因素。方法:选择2009～2020年于安徽医科大学第一附属医院妇科因子宫内膜癌行分期手术的患者1346例为研究对象(其中130例淋巴结阳性),对其临床病理特征行单因素及Logistic、Cox多因素回归模型分析与淋巴结转移及生存期预后的相关因素。结果:(1)单因素分析提示:病理类型、组织学分级、肌层浸润深度、肿瘤直径、子宫颈侵犯、淋巴脉管间隙浸润(LVSI)、术前CA_(125)及卵巢受累与淋巴结转移有关(P0.05)。多因素的Logistic回归分析显示:病理类型为非子宫内膜样癌、子宫颈侵犯、LVSI阳性、术前CA_(125)≥35 U/L、卵巢受累是淋巴结转移的独立危险因素(OR1,P0.05)。(2)单因素分析提示:病理类型、组织学分级、肌层浸润深度、子宫颈侵犯、LVSI、淋巴结转移、卵巢受累及术后辅助治疗与总生存期有关(P0.05)。多因素Cox回归验证及Kaplan-Meier生存曲线显示:非子宫内膜样癌、子宫颈侵犯、LVSI阳性和淋巴结转移是影响总生存期的独立危险因素(HR1,P0.05)。结论:特殊病理类型、子宫颈侵犯、LVSI阳性、术前CA_(125)≥35 U/ml及卵巢受累,对淋巴结转移风险具有独立预测意义。特殊病理类型、子宫颈侵犯、LVSI阳性及淋巴结转移是临床预后不良的有力预测因子。进一步完善子宫内膜癌分期手术和术后病理,为指导患者个体化治疗提供有效帮助。     

淋巴结阳性率在ⅠB～ⅡA期宫颈癌患者中的临床意义

目的:研究淋巴结阳性比率(LNR)对IB~IIA期宫颈癌患者无进展生存期(PFS)及总生存期(OS)的影响。方法:回顾分析2010年1月~2015年12月我院收治的102例经根治性子宫切除±双侧卵巢切除+盆腔淋巴结清扫±腹主动脉淋巴结清扫术的淋巴结转移阳性的102例IB~IIA期宫颈癌患者的临床资料。采用单因素和多因素分析LNR、分期、病理类型、组织学分级、肿瘤大小、辅助治疗对PFS及OS的影响。结果:单因素分析显示,LNR、分期对PFS、OS有显著影响。多因素分析显示,LNR10%的患者PFS更差(HR=0.151,P=0.047,95%CI为0.023~0.974);而LNR10%患者的OS与LNR≤10%者比较,差异无统计学意义。结论:LNR可以作为判断IB~IIA期宫颈癌患者PFS的一项独立危险因素。     

子宫肉瘤与癌肉瘤预后相关因素的分析

目的：探讨子宫肉瘤与癌肉瘤的临床特征及预后的相关因素。方法：回顾性分析2003年1月—2012年12月于复旦大学附属妇产科医院且经手术病理确诊为子宫肉瘤或癌肉瘤的168例患者的临床资料,随访其生存及复发情况。Kaplan-Meier法绘制生存曲线并进行单因素生存分析,Log-rank检验比较2组或多组生存情况,Cox比例风险回归模型进行多因素分析筛选预后相关的危险因素。结果：子宫肉瘤和癌肉瘤患者中位生存时间分别为（125.76±4.99）个月和（86.65±7.84）个月,子宫肉瘤患者总生存期（overall survival,OS）长于癌肉瘤患者（P=0.003）。Cox多因素回归分析显示,肿瘤病理分期是影响子宫肉瘤OS的危险因素（P=0.006）,而病理分期[OS P=0.002,无进展生存期（progress-free survival,PFS）P=0.007]和淋巴结清扫（OS P=0.042,PFS P=0.042）是影响癌肉瘤的危险因素。结论：子宫肉瘤较癌肉瘤预后好,其中肿瘤病理分期越晚,子宫肉瘤与癌肉瘤的OS越短。而对于癌肉瘤,除了肿瘤病理分期外,淋巴结清扫不仅可以显著延长癌肉瘤的OS,还可以提高患者PFS。     

晚期子宫内膜癌患者的治疗及预后分析

目的 探讨晚期(Ⅲ～Ⅳ期)子宫内膜癌的治疗方法及预后影响因素.方法 选择1996年1月至2006年12月间收治的晚期子宫内膜癌患者118例,对其治疗方法及预后影响因素进行回顾性分析,患者随访至2007年12月,平均随访26个月.结果 随访期内,共33例患者死亡,占28.0%;25例患者术后出现疾病进展,占21.2%.Ⅲ、Ⅳ期患者的3年总生存率分别为78.3%和39.4%,子宫内膜样腺癌和非子宫内膜样腺癌患者的3年总生存率分别为69.3%和42.0%,分别比较,差异均有统计学意义(P<0.05).4例仅有腹水细胞学检查阳性的Ⅲa期患者,术后未行辅助治疗,现已平均随访16个月均无瘤生存.单因素分析显示,手术病理分期、病理类型、肌层浸润深度、病理分级、后腹膜淋巴结切除术(包括盆腔淋巴结切除或加腹主动脉旁淋巴结切除术)和术后辅助联合放化疗与预后明显相关(P<0.05).多因素分析显示,手术病理分期和肌层浸润深度与预后明显相关(P<0.05).对不同治疗方式分析显示,行后腹膜淋巴结切除术患者的预后明显优于未行该手术者(P<0.05);术后残留灶直径≤1 cm患者的预后明显优于残留灶直径>1 cm者(P<0.05);术后行辅助联合放化疗患者的预后明显优于未行联合放化疗和仅行放疗或化疗者(P<0.05).结论 手术病理分期和肌层浸润深度是影响晚期子宫内膜癌患者预后的独立的危险因素.治疗应在满意的肿瘤细胞减灭术和后腹膜淋巴结切除术的基础上,除仪腹水细胞学检查阳性的Ⅲa期患者外,术后均应辅以联合放化疗,以改善患者的预后.     

影响复发上皮性卵巢癌化疗疗效的临床病理因素分析

目的:分析影响铂类敏感型及耐药型复发上皮性卵巢癌(EOC)患者预后的相关临床病理因素。方法:回顾分析1985年1月至2011年11月广西医科大学附属肿瘤医院收治的复发EOC患者83例,其中铂类敏感型56例,耐药型27例。采用Kaplan-meier生存率曲线、Log-rank test检验和Cox模型多因素回归分析法分析影响复发EOC患者预后的相关因素。结果:(1)铂类敏感型复发EOC患者的中位无进展生存期(PFS)为11个月(95%CI 9.105～12.895),中位总生存期(OS)为16个月(95%CI 13.144～18.856);铂类耐药型复发EOC患者的中位PFS为8个月(95%CI 4.219～11.781),中位OS为10个月(95%CI 3.824～16.176)。(2)复发后伴有腹水、复发后化疗方案、化疗疗程、化疗效果是影响敏感型复发EOC患者的重要预后因素(P<0.05);无复发生存时间(RFS)、复发后伴有腹水、复发部位、化疗效果是影响耐药型复发EOC患者的重要预后因素(P<0.05)。(3)复发后化疗疗程数、复发后伴有腹水、化疗疗效是影响敏感型复发EOC患者预后的独立危险因素,而复发部位是影响耐药型复发EOC患者预后的独立危险因素。结论:铂类敏感型患者复发后宜选择与一线类似的铂类联合方案化疗,并尽可能化疗至6疗程。复发病灶位于盆腹腔是影响耐药型患者预后的独立危险因素,应积极治疗。     

腹膜后淋巴清扫术对原发性输卵管癌生存预后的影响

目的探讨腹膜后淋巴清扫术在原发性输卵管癌(PFTC)治疗中的作用。方法回顾性分析天津医科大学总医院与天津市中心妇产科医院1995年1月至2008年6月收治的临床资料完整PFTC病例67例,分析腹膜后淋巴清扫术对生存预后的影响并探讨影响PFTC预后的相关因素。结果早期(Ⅰ期和Ⅱ期)患者行腹膜后淋巴清扫者的总生存期(OS)和无进展生存期(PFS)均好于未行腹膜后淋巴清扫者(P=0.020,P=0.025),而晚期患者无论是否行腹膜后淋巴清扫术其OS与PFS差异无统计学意义(P=0.574,P=0.810)。淋巴结阳性患者的OS与PFS均短于阴性者(P0.001,P0.001)。临床分期、腹膜后淋巴结转移、术后残余病灶是PFTC生存预后的独立因素(P=0.021,P=0.038,P=0.031)。结论早期PFTC应行包括腹膜后淋巴清扫术在内的全面分期手术,使患者获得准确的手术分期及恰当的术后辅助治疗;晚期病例采取肿瘤细胞减灭术,尽量缩小残余病灶,以延长患者生存期。     

不同新辅助治疗方式在局部晚期子宫颈癌的临床应用及评价

目的:探讨不同新辅助治疗方式在局部晚期子宫颈癌(LACC)中的临床应用效果。方法:回顾性分析甘肃省妇幼保健院2010～2013年接受住院手术治疗的LACC 260例(鳞癌236例,腺癌12例,腺鳞癌12例)患者的临床资料,根据治疗方式分为新辅助化疗联合腔内后装放疗组82例(NACT+BT组)、单纯新辅助化疗组77例(NACT组)、仅行根治性手术组101例(RH组),通过术后病理危险因素、术后辅助放射治疗率、无进展生存率(PFS)、总生存率(OS)及Cox多因素分析方法来评价不同新辅助治疗方式的临床意义。结果:①与NACT组比较,NACT+BT组能够显著缩小局部肿瘤体积(89.02%vs 76.62%,P0.05)。②NACT+BT组的深肌层浸润率、宫旁侵犯阳性率、脉管内癌栓阳性率均明显低于RH组(P0.05),其深肌层浸润率也低于NACT组(P0.05);NACT组的脉管内癌栓阳性率低于RH组(P0.05)。NACT+BT组术后补充放疗率(30.49%)低于NCAT组(66.23%)和RH组(79.21%),差异有统计学意义(P0.05)。③NACT+BT组的5年PFS(90.95%)显著高于RH组(79.23%),差异有统计学意义(P0.05);3组5年OS比较,差异无统计学意义(P0.05)。④Cox多因素分析显示淋巴结转移阳性(HR 4.79,P0.01)、手术切缘阳性(HR 4.38,P=0.04)和NACT+BT治疗方式(HR 0.24,P=0.03)是影响LACC 5年PFS的独立因素;淋巴结转移阳性(HR 6.47,P0.01)是影响5年OS的独立因素。结论:单纯新辅助化疗可以控制病理中危因素,但没有降低术后辅助放疗率以及改善生存结局。而新辅助化疗联合腔内后装放疗可更好地减少术后病理危险因素,降低术后辅助放疗比率,延长PFS,具有较好的临床应用价值。     

中间性肿瘤细胞减灭术后患者预后的相关因素分析

目的:探讨中间性肿瘤细胞减灭术(ICS)后患者预后的相关因素及其对临床的指导价值。方法:回顾性分析36例行ICS的卵巢癌及原发性腹膜癌患者的临床病理特征、手术、化疗情况等与预后的关系。结果:①单因素分析显示ICS术前CA125及CP2是否正常、术后有无残留病灶3项指标对无进展生存期(PFS)的影响有统计学意义(P<0.05);ICS术中探查病灶大小及术后有无残留病灶两项指标对总生存时间(OS)的影响有统计学意义(P=0.049,P=0.001)。②多因素生存分析显示ICS术前CA125是否正常、术后有无残留病灶是影响PFS的独立因素(P=0.011,P=0.002);肿瘤的组织学分级是影响PFS的相关因素。③多因素生存分析显示ICS术前CP2是否正常、术后有无残留病灶是影响OS的独立因素(P=0.021,P=0.003);肿瘤的组织类型、ICS术后是否辅以全身化疗是影响OS的相关因素。结论:①ICS术前CA125及CP2正常、ICS术后无残留病灶的患者预后更好。②ICS术中尽可能切除肉眼病灶,术后辅助规范足量化疗,对改善患者预后具有重要意义。     

特殊类型子宫内膜癌的临床特征及预后分析

目的:比较特殊类型子宫内膜癌不同病理类型的临床特征及预后,探讨影响特殊类型子宫内膜癌预后的危险因素及辅助治疗。方法:回顾性分析2009年1月至2017年9月青岛大学附属医院初治的135例特殊类型子宫内膜癌的临床资料,比较分析79例子宫浆液性癌(USC组)、15例透明细胞癌(CCC组)、17例癌肉瘤(CS组)和24例混合细胞腺癌(MCA组)的临床特征及预后。结果:①4组患者在年龄≥60岁、绝经、肿瘤大小、盆腔淋巴结转移及大网膜转移比例方面比较,差异均有统计学意义(P<0.05)。②USC组、CCC组、CS组和MCA组患者的5年总体生存率(OS)分别为63.1%、79.4%、37.6%、87.5%,4组间差异有统计学意义(P<0.05)。I期患者术后行单纯化疗、化疗联合放疗和无治疗组的5年OS分别为94.4%、100.0%、58.1%,不同治疗方式组间差异有统计学意义(P<0.05),前2组患者的预后均明显优于无治疗组(P<0.05)。③经Cox回归多因素分析筛选后,深肌层浸润(HR 1.833,95%CI 1.017～3.306)、分期(HR 1.763,95%C...     

Naples prognostic score is an independent prognostic factor in patients with operable endometrial cancer: Results from a retrospective cohort study

ObjectiveNaples prognosis score (NPS) is a new immune and nutritional assessment method that can be used to predict tumor prognosis. This study aimed to identify whether NPS is an independent prognostic indicator of operable endometrial cancer (EC).Materials and methodsWe retrospectively analyzed 1038 patients with endometrial cancer who underwent surgery. Patients were grouped according to NPS (NPS group 0, n = 362; NPS group 1, n = 589; and NPS group 2, n = 87), and differences in clinical characteristics were compared among the groups. Survival analysis was performed by the Kaplan–Meier method, P values were calculated by log–rank test, and prognostic factors were assessed by Cox proportional hazards regression models.ResultsSerum albumin levels, total cholesterol levels, neutrophil–lymphocyte ratio, lymphocyte–monocyte ratio, total lymphocyte count, CA-125 levels, age, body mass index, FIGO stage, myometrial invasion depth, controlling nutritional status score, and systemic inflammation score were significantly different among the groups; significant differences in progression-free survival(PFS) and overall survival (OS) were also found. On multivariate analysis, NPS was identified as an independent prognostic factor for PFS (NPS group 0 vs. 1: aHR = 4.32, 95%CI = 1.133–16.47; NPS group 0 vs. 2: aHR = 21.336, 95%CI = 3.498–130.121) and OS (NPS group 0 vs. 1: aHR = 5.029, 95%CI = 1.638–15.441; NPS group 0 vs. 2: aHR = 20.789, 95%CI = 4.381–98.664). Moreover, NPS is an independent prognostic factor for PFS and OS in grade 2 or 3 EC (aHR = 7.768, 95%CI = 2.411–25.029 and aHR = 4.717, 95%CI = 1.794–12.407, respectively).ConclusionHigh NPS is associated with poor PFS and OS and is a valuable independent prognostic factor in patients with EC.     

The prognostic significance of positive peritoneal cytology and adnexal/serosal metastasis in stage IIIA endometrial cancer

OBJECTIVE: The clinical significance and optimal management of patients with stage IIIA endometrial cancer are controversial. We sought to determine whether recurrence and survival of patients with stage IIIA endometrial cancer differ with surgical pathologic findings (positive peritoneal cytology versus positive adnexae or serosa) and adjuvant treatment. METHODS: Retrospective single institution analysis of patients surgically staged for IIIA endometrial cancer at Duke University Medical Center from 1973 to 2002. Stage IIIA patients were stratified into positive cytology alone (group IIIA1, n=37) and positive adnexae or uterine serosa (group IIIA2, n=20). Comparison was made with previously reported group of 467 patients with surgical stage I/II disease. Recurrence and survival were analyzed using Kaplan-Meier estimations and Cox proportional hazards model. RESULTS: Mean age of 57 patients with stage IIIA endometrial cancer was 63. Adjuvant therapies were administered to 89% patients (74% radiotherapy, 4% chemotherapy, 19% progestins). Five-year overall (OS) and recurrence-free disease-specific survival (RFDSS) were 64% and 76%, respectively. Survival was similar comparing IIIA1 (62%) and IIIA2 (68%, p=0.999). RFDSS by adjuvant therapy was: external beam radiotherapy 89% (n=10), intraperitoneal P32 84% (n=21), progestins 78% (n=9), none 75% (n=6). 61% recurrences included extrapelvic component. In multivariable analysis of stage I-IIIA patients (n=517), positive cytology but not adnexal/serosal metastasis was predictive of death (HR 1.70, 95% CI 1.06-2.73) and disease recurrence (HR 1.70, 95% CI 1.07-2.71). CONCLUSION: Among patients with stage IIIA endometrial cancer, metastasis to adnexae or serosa does not appear to confer worse prognosis than positive cytology alone. Positive cytology is an independent predictor of prognosis among patients with stage I-IIIA endometrial cancer. While optimal adjuvant therapy for these groups remains unclear, recurrence patterns suggest that systemic therapies are appropriate.     

A novel autophagy-related gene signature associated with prognosis and immune microenvironment in ovarian cancer

Apatinib is an oral anti-angiogenic drug that mainly targets vascular endothelial growth factor receptor 2 (VEGFR-2) and is widely used in a variety of solid tumours. The purpose of this study is to evaluate the clinical efficacy and safety of apatinib in patients with advanced platinum-resistant relapsed epithelial ovarian cancer (EOC). A retrospective analysis was performed, the clinical data of patients with stage IIIC-IV platinum-resistant relapsed EOC between January 2014 and May 2018 were collected. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were reviewed and evaluated. The propensity score matching (PSM) method was used to determine the final case data included in this study. According to 1:2 propensity matching, 108 patients were finally taken into account: 36 in the apatinib group and 72 in the control group. The follow-up ended in January 2019, and the median follow-up time was 28 months. In the apatinib group, ORR was 30.56% and DCR was 66.67%, whereas in the control group, ORR was 16.67% and DCR was 44.44%. In the apatinib group, median PFS was 6.0 months (95% CI 3.69–8.31) and median OS was 15.8 months (95% CI 6.99–24.6), while in the control group, median PFS was 3.3 months (95% CI 2.44–4.16) and median OS was 9.2 months (95% CI 6.3–12.06); the difference was statistically significant (P < 0.05). Apatinib was more effective than conventional chemotherapy in reducing the risk of PFS [HR 0.40 (95% CI 0.22–0.76), P = 0.0017] and OS [HR 0.40 (95% CI 0.21–0.73), P = 0.002]. Multivariate Cox analysis showed that the course of treatment and decrease in serum CA125 levels are independent risk factors for PFS in patients, while apatinib, the length of treatment course and the location of the lesion are independent risk factors for recurrence affecting the OS of patients. The main grade 3–4 adverse events in the apatinib group were hypertension, hand-foot syndrome, and oral mucosal ulcers, and all adverse events were controllable. Apatinib was found to be both safe and effective in patients with advanced platinum-resistant relapsed EOC. More in-depth clinical research and applications should be carried out.     

宫颈小细胞癌与非小细胞癌临床特征及预后的对比研究

目的:对比性研究宫颈小细胞癌(SCCC)与宫颈非小细胞癌在发病特点、临床特征、治疗方案、预后情况等方面的差异,并探究影响其预后的因素。方法:回顾性分析2003年5月至2015年6月四川大学华西第二医院收治的宫颈小细胞癌患者63例(SCCC组)和根据诊断时间及相近的FIGO分期配对的宫颈非小细胞癌(鳞癌、腺癌)患者60例(对照组)的临床病理资料及生存情况,采用Pearson卡方检验或Fisher确切概率法比较两组临床特征、治疗方案等方面的差异,Kaplan-Meier方法比较两组总体生存率及无病生存率的差异,单因素和多因素分析影响SCCC预后的因素。结果:(1)SCCC组患者初诊的中位年龄较对照组年轻(40岁vs 44岁,P=0.001),淋巴结转移率、宫旁浸润率、脉管累及率及手术切缘阳性率也均显著高于对照组(P0.05)。而在临床症状、肿块大小、诊断分期、术前治疗、术后治疗等方面比较两者差异均无统计学意义(P0.05)。(2)生存分析中,SCCC组的累积5年生存率(29.2%)与累积5年无瘤生存率(26.6%),显著低于对照组(分别为82.6%、76.7%),差异有统计学意义(P0.05)。(3)在影响SCCC预后的多因素COX多元回归分析结果显示,有淋巴结转移是影响患者5年总生存率和5年无瘤生存率的独立危险因素(HR=4.784、3.067,P0.05)。肿块直径≥4 cm是影响5年总生存率的独立危险因素(HR=3.610,P0.05)和FIGO分期(ⅠB2以上)是影响无瘤生存率的独立危险因素(HR=2.793,P0.05)。结论:SCCC患者更年轻,其临床症状、病灶外观、治疗方案等和宫颈非小细胞癌相似,但淋巴结转移率、脉管累及率、宫旁浸润率及手术切缘阳性率均显著高于宫颈非小细胞癌,预后极差。影响SCCC患者预后的主要因素为有无淋巴结转移、FIGO分期、肿块直径。     

Outcome of uterine clear cell carcinomas compared to endometrioid carcinomas and poorly-differentiated endometrioid carcinomas

OBJECTIVES: Our aim was to compare the survival between patients with clear cell carcinoma (CC) and patients with endometrioid carcinoma (EC). METHODS: Through the population-based Geneva Cancer Registry, we identified 1,380 resident women diagnosed with uterine cancer between 1970 and 2000. We excluded those with papillary serous endometrial carcinoma and uterine sarcomas. We categorized patients as CC (n = 32, 2.8%) or EC (n = 1,145, 97.2%). Uterine cancer-specific survival rates were calculated by Kaplan-Meier analysis. We used Cox proportional hazards analysis to compare uterine cancer mortality risks between groups, and adjusted these risks for other prognostic factors. RESULTS: CC patients presented with a more advanced stage at diagnosis than EC patients (p = 0.002). Compared to women with EC, women with CC had a significantly greater risk of dying from their disease (hazard ratio [HR] 2.9, 95% confidence interval (95% CI) 1.7-4.9). After adjustment for age, stage and adjuvant chemotherapy, the risk of dying from uterine cancer was still significantly higher for CC patients (HR 2.0, 95% CI 1.2-3.4). By univariate analysis, the risk of dying of endometrial cancer was not significantly higher in CC patients than in patients with poorly-differentiated EC (HR 1.3, 95% CI 0.7-2.3). CONCLUSION: This population-based investigation shows that patients with CC have a poorer outcome than those with EC. Studies to determine the role of adjuvant treatment in CC patients are needed.     

子宫内膜癌患者腹腔细胞学阳性的临床意义及对预后的影响

目的 探讨子宫内膜癌患者腹腔细胞学阳性的临床意义及对预后的影响.方法 对1996年1月至2008年12月复旦大学附属肿瘤医院收治的315例子宫内膜癌患者的临床病理资料进行回顾性分析,所有患者均行手术治疗,且均行术中腹水或腹腔冲洗液细胞学检查.对与腹腔细胞学阳性相关的因素,采用相关分析法进行分析;对影响子宫内膜癌患者预后的因素,采用log-rank检验进行单因素分析,采用Cox回归法进行多因素分析.结果 (1)315例子宫内膜癌患者中,30例(9.5%)患者腹腔细胞学阳性.腹腔细胞学阳性与多个子官内高危因素包括病理类型(P=0.013)、手术病理分期(P=0.000)、肌层浸润(P=0.012)、脉管浸润(P=0.012),以及多个子宫外转移危险因素包括子宫浆膜层侵犯(P=0.004)、宫颈受累(P=0.016)、附件转移(P=0.000)和大网膜转移(P=0.000)明显相关,而与病理分级(P=0.152)、淋巴结转移(P=0.066)无明显相关性.(2)315例子宫内膜癌患者的3年总生存率和3年无疾病进展生存率分别为93.0%和85.5%.单因素分析显示,腹腔细胞学阳性及不同手术病理分期、病理类型、肌层浸润深度、病理分级和脉管浸润是影响子宫内膜癌患者预后的危险因素(P＜0.05);多因素分析显示,手术病理分期、肌层浸润深度是影响子宫内膜癌患者预后的独立危险因素(P＜0.05).30例腹腔细胞学阳性患者中,无高危因素患者的3年生存率和3年无疾病进展生存率均显著高于有高危因素者(P＜0.05);进一步分析显示,腹腔细胞学阳性是影响晚期(Ⅲ～Ⅳ期)子官内膜癌患者预后的独立危险因素(P=0.006).结论 腹腔细胞学阳性与多个子宫内高危因素和子宫外转移危险因素密切相关,是影响晚期子宫内膜癌患者预后的独立危险因素.因此,腹水细胞学检查应继续作为全面分期手术的步骤之一,并将结果单独进行报告,是十分有必要的.

Abstract：

Objective To evaluate the clinical significance of positive peritoneal cytology in patients with endometrial cancer.Methods The records of 315 patients with endometrial cancer who were operated at Cancer Hospital, Fudan University between January 1996 and December 2008 were reviewed.Peritoneal cytology were performed and diagnosed in all patients.Factors related with peritoneal cytology were analyzed by correlation analysis.Log-rank test and Cox regression test was used for the analysis of prognosis,respectively.Results (1) Peritoneal cytology were positive in 30 (9.5%) patients.Positive peritoneal cytology was associated with pathological subtype ( P = 0.013 ), stage ( P = 0.000 ), myometrial invasion ( P =0.012), lymph-vascular space invasion ( P = 0.012 ), serosal involvement ( P = 0.004 ), cervical involvement ( P = 0.016), adnexal involvement ( P = 0.000), and omental involvement ( P = 0.000), with no association with grade ( P = 0.152 ) and lymph node metastasis ( P = 0.066 ).( 2 ) Three-year overall survival (OS) and progression-free survival(PFS) were 93.0% and 85.5% ,respectively.Positive peritoneal cytology, surgical stage, pathological subtype, myometrial invasion, grade, and lymph-vascular space invasion were significantly associated with worse prognosis by univariate analysis ( P ＜ 0.05 ), while only surgical-pathology stage and myometrial invasion were independent prognostic factors by multivariate analysis ( P ＜ 0.05 ).For 30 cases with positive peritoneal cytology, the patients with no high risk factors shown significantly prognoses better than those with any risk factors.The results shown that for patients with late stage (stage Ⅲ - Ⅳ ) endometrial cancer with positive peritoneal cytology was significantly associated with the worse OS and PFS by multivariate analysis ( P = 0.006).Conclusions Positive peritoneal cytology was associated with serosal involvement, cervical involvement, adnexal involvement, omental involvement, and late stage.Therefore, peritoneal cytology should be performed and reported separately as a part of full surgical staging procedure.     

Which clinical/pathologic factors matter in the era of chemoradiation as treatment for locally advanced cervical carcinoma? Analysis of two Gynecologic Oncology Group (GOG) trials

PURPOSE: To explore clinical/pathologic factors associated with prognosis of patients with locally advanced cervical carcinoma treated with weekly cisplatin and pelvic radiation. METHODS: We retrospectively reviewed data from 335 women who received weekly cisplatin and radiation while participating in similar arms of two GOG studies (protocols 120 and 165). Progression-free survival (PFS) and overall survival (OS) were evaluated for associations between clinical/pathologic factors and prognosis. Prognosis and selected toxicities were also compared between studies. RESULTS: Four-year PFS and OS for stage II patients were 64.2% and 68.1%, respectively for those treated on GOG 120 and 65.8% and 73.9% for those treated on GOG 165, compared to 51.4% and 55.4% for stage III/IV patients respectively treated on GOG 120 and 37.7% and 42.7% respectively for those treated on GOG 165. In multivariate analysis, stage, tumor grade, race and age were independently predictive of PFS and OS (for all, p<0.05). Prolonged (delayed for any cause) radiation was associated with poorer PFS (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.16-3.38; p=0.012) and OS (HR, 1.88; 95% CI, 1.08-3.26; p=0.024) in GOG 165 but not GOG 120. CONCLUSIONS: FIGO stage, tumor grade, race and age are prognostic in patients with locally advanced cervical carcinoma treated with concurrent cisplatin and radiation. This exploratory analysis has generated a hypothesis that clinical staging (as per GOG 165) is less sensitive in detecting aortic nodal metastases compared to surgical staging (as per GOG 120) and may be associated with poorer prognosis particularly when radiation is prolonged. Prospective clinical studies are needed to test this hypothesis.     

Surgical cytoreduction in stage IV endometrioid endometrial carcinoma

Objective

To evaluate the role of surgical cytoreduction and the amount of residual disease in patients with newly diagnosed stage IV endometrioid endometrial carcinoma (EC).

Methods

Patients with stage IV EC of endometrioid histology who underwent surgery at our institution from 1977 to 2003 were identified. Patients with microscopic stage IV disease were excluded. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan Meier method and compared with log-rank test.

Results

A total of 58 patients were identified, of which 9 (15.5%) had no gross residual (NGR) after surgery, 11 (19.0%) had residual disease ≤ 1 cm, 32 (55.1%) had residual disease > 1 cm, and 6 (10.3%) had no cytoreduction attempted. The median PFS was 11.1 months (95% CI, 9.8-12.3) and the median OS was 19.2 months (95% CI, 8.5-29.9) for the cohort. The median PFS was 40.3 months (95% CI, 0-93.9) for patients with NGR disease, 11 months (95% CI, 9.9-12.1) for patients with any residual disease, and 2.2 months (95% CI, 0.1-4.2) for patients who did not have attempted cytoreduction (P < 0.001). The median OS was 42.2 months (95% CI, not estimable) for patients with NGR disease, 19 months (95% CI, 13.9-24.1) for patients with any residual disease, and 2.2 months (95% CI, 0.1-4.2) for patients that did not have attempted cytoreduction (P < 0.001).

Conclusion

Though stage IV endometrioid EC has a poor prognosis, surgical cytoreduction to no gross residual disease in a highly select group of patients is associated with improved survival.     

The prognostic significance of preoperative leukocytosis in epithelial ovarian carcinoma: A retrospective cohort study

Objective

Preoperative leukocytosis is known to be a negative prognostic factor for several gynecologic malignancies, but its relationship with epithelial ovarian carcinoma (EOC) is unknown. We sought to evaluate the prognostic implications of preoperative leukocytosis for women with EOC.

Methods

We retrospectively reviewed the medical records of patients who underwent primary debulking surgery and adjuvant platinum-based chemotherapy for EOC between January 1993 and October 2011. Associations between leukocytosis and recurrence-free survival (RFS) and overall survival (OS) were determined by univariate analyses. Multivariate Cox proportional hazards regression was used to identify independent prognostic factors for RFS and OS.

Results

Of 155 women, 23 (14.8%) had leukocytosis and 132 (85.2%) did not have leukocytosis. RFS and OS were significantly shorter for women with leukocytosis than for women without leukocytosis (P = 0.009 and P < 0.0001, respectively). The mortality rate was also higher among women with leukocytosis (P < 0.0001). Multivariate analysis revealed that preoperative leukocytosis (hazard ratio [HR]: 2.15; 95% confidence interval [CI]: 1.55–4.41; P = 0.009), advanced stage (HR: 3.12; 95% CI: 1.44–6.75; P = 0.004), and optimal cytoreduction (HR: 0.38; 95% CI: 0.14-0.70; P = 0.031) were independent prognostic factors for RFS. Additionally, preoperative leukocytosis was independently associated with decreased OS (HR: 7.66; 95% CI: 2.78–21.16; P < 0.0001).

Conclusions

Among women with EOC, preoperative leukocytosis might be an independent prognostic factor for RFS and OS. A larger-scaled, prospective study is needed to verify these results.