特殊类型子宫内膜癌临床特征与治疗

特殊类型子宫内膜癌的临床特征与子宫内膜样腺癌不同,其生物学行为高度恶性,容易发生远处转移。文章对该类肿瘤的临床特征与治疗进行了阐述,强调综合治疗。     

子宫乳头状浆液性癌

子宫乳头状浆液性癌 (ｕｔｅｒｉｎｅｐａｐｉｌｌａｒｙｓｅｒｏｕｓｃａｒｃｉｎｏ ｍａ ,ＵＰＳＣ)是子宫内膜癌的一种特殊组织类型 ,与普通的子宫内膜癌相比 ,无论是在肿瘤的发生、病理学改变 ,还是临床表现和处理等方面都存在着显著的差异。近年来引起人们的关注。尽管 ,早在 194 7年 ,Ｎａｖａｋ等人就报道了具有乳头状结构的子宫内膜癌 ,但ＵＰＣＳ的正式命名是在 1982年 ,由Ｈｅｎｄｒｉｃｋｓｏｎ等人提出。通过进一步研究发现 ,ＵＰＳＣ的发生与高雌激素状态无关 ,患者几乎全部为绝经后的老年妇女 ,通常既不肥胖也无糖尿病。ＵＰ…     

子宫浆液性癌的诊治进展

子宫浆液性癌[USC,又称子宫乳头状浆液性癌（UPSC）],是非雌激素依赖性Ⅱ型子宫内膜癌的重要类型之一。其具有高度恶性的生物学特性：侵袭性强、术后复发率高,多灶性复发且病灶多位于盆腔以外的特点导致无法再用手术、放疗等方法进行挽救处理。因该病发病率不高,既往的小数据研究无法进行精细的分组统计,本文列举近年来多篇大数据回顾分析结果,并参照美国妇科肿瘤协会（SGO）与美国国立综合癌症网络（NCCN）对UPSC的治疗建议,介绍该病的临床特点,对不同FIGO分期的各种处理方式提供数据支持,旨在提高大家对该病的认识以掌握对该病的处理原则。     

子宫内膜浆液性癌的分子特征研究进展

子宫内膜浆液性癌(USC)是一种侵袭性的高级别子宫内膜癌(EC)亚型,因其具有高度转移性,在EC的复发和死亡中所占比例极高,5年的总体生存率为45%。在精准医学的时代,对这种侵袭性肿瘤靶向治疗方法的需求日益增长。本文就USC的关键分子特征研究进展进行综述,以期为USC的精准治疗提供信息,提高USC患者的生存率,为USC患者带来新的希望。     

子宫浆液性乳头状癌：一个单中心的129例分析

在美国,子宫内膜癌是妇科最普遍的恶性肿瘤,2003年患病人数超过41000例。大部分患者为子宫内膜样癌,仅约5%为子宫浆液性乳头状癌(UPSC),UPSC患者既便发病时有微小的肌层浸润,也和远处转移有关。为明确UPSC患者的临床及病理特点进行研究。自1989～2002年在Anderson癌检中心共有129例I～IV期患者纳入研究,排除子宫肉瘤和恶性混合性苗勒氏管瘤。记录每个患者的临床资料及病理报告,手术分期定义为经腹全子宫切除术,双附件切除术,盆腔细胞学评价,大网膜和盆腔淋巴结活检,按1988年FIGO手术分期标准分期。病理诊断均由Anderson癌检中心的…     

子宫浆液性癌的诊治进展

子宫浆液性癌[USC,又称子宫乳头状浆液性癌(UPSC)],是非雌激素依赖性Ⅱ型子宫内膜癌的重要类型之一。其具有高度恶性的生物学特性:侵袭性强、术后复发率高,多灶性复发且病灶多位于盆腔以外的特点导致无法再用手术、放疗等方法进行挽救处理。因该病发病率不高,既往的小数据研究无法进行精细的分组统计,本文列举近年来多篇大数据回顾分析结果,并参照美国妇科肿瘤协会(SGO)与美国国立综合癌症网络(NCCN)对UPSC的治疗建议,介绍该病的临床特点,对不同FIGO分期的各种处理方式提供数据支持,旨在提高大家对该病的认识以掌握对该病的处理原则。     

子宫内膜乳头状浆液性癌的研究进展

子宫内膜浆液性乳头状癌(UPSC)是子宫内膜癌的一种特殊类型,有独特的生物学行为和病理特征。其恶性度高,预后差。此病的发病机制目前不清,术前诊断率低,治疗处于探索阶段。现将近年对UPSC病因、病理、诊断、治疗、预后等方面的进展做一综述。     

子宫内膜浆液性癌发病起源的研究进展

子宫内膜浆液性癌(ESC)因其恶性度高,近年来受到极大重视,然而对其发病机制的认识不足,且患者通常无明显症状,死亡率高,预后差,因此,明确ESC的发生、发展过程对精确分期、指导治疗具有重要意义。本文复习国内外关于ESC发病起源的研究结果,提出两种假设,即子宫内膜起源学说和输卵管起源学说,并论述两种学说的科学依据,为进一步探索ESC的发病机制提供思路。     

子宫浆液性癌101例临床分析

目的探讨子宫浆液性癌的临床病理特征和预后影响因素。方法回顾性分析2000年1月至2010年12月广东省子宫内膜癌防治项目101例子宫浆液性癌的临床病理特征及预后。结果子宫浆液性癌占同期子宫内膜癌的1.7%,患者的发病平均年龄(56.2±10.3)岁,多发于绝经后妇女(67.3%)。子宫浆液性癌术前的误诊率较高(74.7%),容易与低分化子宫内膜样腺癌混淆。术前CA125升高的患者多数为晚期(72.4%)。临床Ⅰ期患者术后分期升级占38.1%。无肌层浸润的患者中发生子宫外转移占38.5%。深肌层浸润占35.6%;淋巴血管间隙受累占16.8%;淋巴结转移占29.7%,其中无/浅肌层浸润占47.4%。86.2%的患者p53呈阳性。术后复发以远处转移为主,占77.3%(17/22)。子宫浆液性癌的5年总体生存率和5年无进展生存率分别为74.9%和67.9%;多因素分析显示,淋巴结转移是影响子宫浆液性癌总体生存率和无进展生存率的独立因素(P=0.015,P=0.001)。结论子宫浆液性癌发病年龄较大,多见于绝经后女性,术前病理误诊率高,易于发生子宫外转移,术前CA125升高对预测子宫外转移有一定意义。p53阳性是其重要的分子生物学特征。复发以远处转移为主,淋巴结转移是预后的重要影响因素。     

子宫内膜浆液性乳头状癌的研究进展

子宫内膜浆液性乳头状癌（UPCS）是子宫内膜癌的一种特殊类型，有着独特的生物学行为和病理特征。其发病率较低，但恶性度高，预后差。目前，该病的危险因素、预后因素尚不确定，术前诊断率低，发病机制亦无定论，治疗仍处于探索阶段。对国外近5年在UPSC的病因、诊断、治疗等方面新的理念、方法作文献综述。     

Comparison of outcomes in early stage uterine carcinosarcoma and uterine serous carcinoma

Objective

To assess whether contemporary adjuvant management of early stage uterine carcinosarcoma (CS) produces equal outcomes as in uterine serous carcinoma (USC).

Methods

We reviewed 172 women treated from 2000 to 2011 for stage I–II USC (n = 112, 65%) or CS (n = 60, 35%). Adjuvant therapy was initiated in 154 (90%) patients, with 111 patients receiving intravaginal radiotherapy (IVRT)/chemotherapy. Median follow up was 4.6 years for surviving patients.

Results

Characteristics for USC vs. CS did not differ significantly by age ≥ 60, pelvic or para-aortic node sampling, stage, lymphovascular invasion, chemotherapy use, RT use or omission of adjuvant therapy. Outcomes were better for USC vs. CS in 5-year actuarial rates of recurrence [17% (C.I. 10–25%) vs. 45% (C.I. 31–59%), p < 0.001],disease-related mortality (DRM) [11% (5–17%) vs. 30% (16–44%), p = 0.016], and all-cause mortality [12% (C.I. 6–18%) vs. 34% (C.I. 20–48%), p = 0.007]. In multivariable analysis, CS histology remained a significant predictor of risk for recurrence [HR 3.1 (C.I. 1.7–5.7), p < 0.001], DRM [HR 2.4 (C.I. 1.1–5.1), p = 0.024], and all-cause mortality [HR 2.4 (C.I. 1.2–4.8), p = 0.012]. On sub-group analysis of 111 patients (77 USC, 34 CS) able to receive IVRT/chemotherapy, CS no longer was associated significantly with increased recurrence (29% vs. 15%, p = 0.18), DRM (22% vs. 10%, p = 0.39), or all-cause mortality (22% vs. 10%, p = 0.45).

Conclusions

CS was associated with worse outcomes than USC. However, that difference was not maintained in patients able to receive IVRT and chemotherapy. While intriguing, this result may be due in part to selection against rapid early relapsing CS patients in this group.     

Uterine serous carcinoma: a comparison of therapy for advanced-stage disease

Management of advanced-stage uterine serous carcinoma (USC) is uncertain, and postsurgical therapeutic options swing between radiation and chemotherapy. The aim of this study is to evaluate the utility of radiotherapy compared to platinum-based chemotherapy in women with advanced-stage USC. We retrospectively identified cases of USC at our institution. Survival distributions were calculated by the Kaplan-Meier method. Two-tailed t-tests were used to compare time to progression and time to death. We identified 24 women diagnosed with either stage III or IV USC. Time to progression for women receiving radiotherapy was 5.3 months as compared with 12.4 months for women receiving chemotherapy (P = 0.01). Mean time to death for the radiotherapy group was 8 months compared to 18 months in the chemotherapy group (P = 0.04). Kaplan-Meier survival curves were significantly different between the two groups (P = 0.01). While radiotherapy appears to control USC recurrences in the pelvis, the disease often recurs distantly. When compared to radiotherapy, platinum-based chemotherapy appears to increase disease-free survival and time to death in women with advanced-stage USC.     

Depressed host immunity in a case of metachronous primary uterine papillary serous carcinoma and non-Hodgkin''s lymphoma

Metachronous primary malignant tumors of uterine papillary serous carcinoma (UPSC) and non-Hodgkin's lymphoma (NHL) are rare. UPSC is a clinically aggressive and morphologically distinctive variant of endometrial carcinoma. We describe the clinical features of a 63-year-old patient with UPSC that was found 2 years after chemotherapy for malignant lymphoma of neck, stage IV and 5 months after radiation therapy for recurrence. This patient had undergone staging surgery and postoperative radiation for UPSC. One month after completion of radiotherapy, the patient expired due to persistence of the disease. The association between host immunity and UPSC is rarely described in the literature. Immunological profiles of this patient, with compositional changes of natural killer, B, and T cell, dramatically altered the percentage of CD4(+) T cell, CD8(+) T cell, and CD4/CD8 ratio, signifying depressed host immunity. Immunological profile of this patient stressed the issue of depressed host immunity and associated malignancies.     

A review of the pathology and management of uterine papillary serous carcinoma and correlation with outcome

Uterine papillary serous carcinoma (UPSC) accounts for 10% of endometrial carcinomas but a higher proportion of deaths due to its aggressive nature and poor response to chemotherapy and radiotherapy. In order to add to the knowledge of UPSC in the literature and to review our local practices, we examined the pathology, medical records, and management of all cases of UPSC (67 patients) treated in South East Scotland over a 10-year period and also evaluated the prognostic significance of the percentage of UPSC in endometrial pipelle and hysterectomy specimens. Although only 63% of initial diagnostic biopsies were reported to contain UPSC, rereview of the cases revealed UPSC in 98.5% of the preoperative biopsies. The percentage of UPSC in the tumors did not affect the outcome. Stage, positive omentum, and treatment with external-beam +/- intracavitary radiotherapy were significantly correlated with overall survival and progression-free survival by univariate analysis, but only stage (P < 0.01) was correlated with outcome on multivariate analysis. Chemotherapy did not affect outcome. UPSC may be difficult to diagnose in preoperative biopsies, particularly when present as part of a mixed tumor. Even a small percentage of UPSC in a diagnostic biopsy or hysterectomy specimen is correlated with a poor prognosis. This study emphasizes the need of a cooperative, prospective study on this distinct uterine carcinoma.     

34例子宫内膜浆液性乳头状癌临床病理分析

目的 探讨子宫内膜浆液性乳头状癌（uterine papillary serous carcinoma，UPSC）的临床病理特征，以及合理的治疗方法。方法 对2000年1月～2004年12月我院收治的34例UPSC进行回顾性研究，对其发病趋势、危险因素、临床表现、病理特征、目前诊断方法和治疗方案进行统计学分析。结果 Ⅲ、Ⅳ期患者占44．1％，深肌层及以上浸润者占70．6％。64．7％患者术后病理分期高于术前临床分期。91．2％患者雌孕激素受体阴性。全部患者手术治疗，绝大部分术后辅以化疗、放疗，生存率较以往文献提高，但仍较其他类型子宫内膜癌差。结论 UPSC不同于其他类型子宫内膜癌，其特殊的生物学行为和病理特征决定UPSC具有高度恶性表现。随着对其逐步认识，目前诊断和治疗均较以往有较大提高。     

260例子宫肌瘤临床分析

目的:探讨子宫肌瘤手术治疗术式选择。方法:回顾分析我院260例子宫肌瘤患者,对其症状进行分析,并对需手术235例进行手术方式探讨。结果:260例患者中,伴有子宫肌瘤相关症状者185例,占71.15%。无临床症状75例,占28.85%。235例手术中,有183例行全子宫切除术,占手术病例77.87%。结论:子宫肌瘤患者有一部分无临床症状,定期体检是早期诊断的主要方法。手术方式选择应根据患者年龄、瘤体的大小、部位、对生育的要求,并尽量保留卵巢功能。