子宫内膜癌预后相关因素的多元回归分析

目的 探索影响子宫内膜癌患者预后的相关因素及各因素间关系,系统评估其预后因素,制定合理的治疗方案.方法 回顾分析86例患者的临床资料、病理资料,采用单因素和多因素分析方法,研究影响子宫内膜癌患者预后的相关因素及各因素间关系.结果 单因素分析表明:临床分期、宫颈受累情况、腹腔细胞学情况、手术-病理分期、组织学类型、病理分级、肌层浸润、雌孕激素受体表达、淋巴结处理、术后辅助治疗、附件转移、淋巴管转移情况是影响子宫内膜癌预后的相关因素.多因素回归分析表明:手术-病理分期、组织学类型、病理分级、肌层浸润深度、宫颈受累情况是影响子宫内膜癌预后的独立因素.结论 手术-病理分期、组织学类型、宫颈受累情况、病理分级、肌层浸润深度是子宫内膜癌独立的预后影响因素.     

子宫内膜癌手术预后因素的多因素分析

目的:分析和评价子宫内膜癌常用临床病理因素(绝经前后、手术病理分期、组织学分级、淋巴结转移、病理类型、术后辅助治疗、肌层浸润深度)和生物学因素(COX-2、VEGF、KDR及ER、PR)对子宫内膜癌手术预后的影响,筛选出对子宫内膜癌手术预后最有显著的影响因素.方法:将可能与子宫内膜癌预后有关的常用临床病理因素和生物学因素进行单因素分析.通过Cox模型对单因素分析筛选出的影响子宫内膜癌预后的因素进行多因素分析.结果:137例子宫内膜癌患者中,通过随访,共获得确切随访者112例,5年生存率为83.04%.Ⅰ～Ⅳ期5年生存率分别为89.66%,80.00%,53.85%,0.子宫内膜癌组织中COX-2、VEGF及KDR蛋白的阳性率分别为47.32%、66.07%及52.68%,且三者表达具有协同性.COX-2、VEGF、KDR蛋白阳性患者5年累积生存率分别为75.47%、78.38%、72.88%.将这些临床病理因素及生物学因素进行单因素分析,结果手术病理分期、组织学分级、肌层浸润深度、有无淋巴结转移、COX-2阳性表达、KDR阳性表达、ER阳性表达、PR阳性表达8个因素与预后明显相关(P 均＞＜0.05＝,绝经前后、病理类型、术后辅助治疗、VEGF阳性表达与预后无关(P 均＞0.05).应用Cox模型对单因素分析筛选出的8个有显著意义的因素进行多因素分析表明:肌层浸润深度、手术病理分期、组织学分级是影响子宫内膜癌手术预后最显著的3个因素.结论:肌层浸润深度、手术病理分期、组织学分级是影响子宫内膜癌手术预后的因素,但浸润肌层是影响子宫内膜癌手术预后的最重要的因素.     

106例子宫内膜癌术后联合放射治疗疗效及预后因素分析

[目的]探讨子宫内膜癌手术后辅助放射治疗的疗效及其预后因素。[方法]接受术后辅助放疗的子宫内膜癌患者106例，直线加速器盆腔野体外照射，24例加阴道施源器HDR腔内后装治疗。按患者年龄、手术病理分期、肌层浸润、病理类型、病理分级、淋巴结转移6个观察指标分析与5年生存率的关系。[结果]全组5年生存率53．6％。年龄、手术病理分期、肌层浸润、病理类型、淋巴结转移与术后生存率显著相关（P〈0．05），病理分级与生存率无明显相关（P〉0．05）。[结论]子宫内膜癌手术后辅助放射治疗的疗效肯定，年龄、手术病理分期、肌层浸润、病理类型、淋巴结转移是影响子宫内膜癌生存率的预后因素。     

68例子宫内膜癌的临床病理分析

目的 回顾子宫内膜癌患者的临床及病理资料,对比分析其临床分期与手术病理分期的差异,为该肿瘤的诊断、治疗及判断预后提供依据.方法 对我院2005-2008年收治的68例子宫内膜癌的临床及病理资料进行回顾性分析.结果 患者平均年龄55.1岁,未绝经者占33.82%,绝经者症状多是阴道不规则出血伴阴道排液;临床分期与手术病理分期误差率较大,达22.86%一61.11%,术前诊刮与术后病理类型的符合率为86.79%;子宫内膜癌肌层浸润、临床分期及组织学分级均与淋巴结转移密切相关.肌层浸润越深、临床分期越高、组织分化程度越低,淋巴结转移率越高.结论 术前临床分期与手术病理分期,术前诊刮病理诊断结果与术后组织学类型间均存在差异,术前应进行综合检查及评估;肌层浸润深度、临床分期及组织学分级均与淋巴结转移密切相关,是影响预后的重要因素.     

青年妇女子宫内膜癌预后因素分析

[目的]探讨影响青年子宫内膜癌的预后因素。[方法]对52例40岁以下子宫内膜癌患者的临床资料进行回顾性分析。[结果]总5年生存率78．8％。在单因素分析中，妊娠次数、分期、病理类型及分级、肌层浸润、脉管瘤栓、卵巢转移、盆腔淋巴结转移和p53过度表达与预后有关。多因素分析显示仅肌层浸润，脉管瘤栓，盆腔淋巴结转移与预后有关。[结论]肌层浸润，脉管瘤栓，盆腔淋巴结转移是青年子宫内膜癌的独立预后因素。应慎行保留卵巢的手术．Ⅳ期青年患者应争取行手术为主的综合治疗。     

子宫内膜癌手术前后分期的相关性(附80例分析)

目的探讨子宫内膜癌临床分期与手术病理分期的差异及影响因素.方法对80例子宫内膜癌患者中术前有临床分期的67例患者与术后手术病理分期比较,分析两种分期的差异,并分析影响子宫内膜癌临床分期的因素.结果67例术前有临床分期的子宫内膜癌患者中48例与手术病理分期相符,误差为28.36%.分析80例子宫内膜癌患者临床分期的影响因素中绝经前后、孕产次对内膜癌肌层浸润及浸润深度影响有临床意义(P＜0.05),而合并子宫肌瘤、子宫腺肌症则对病灶肌层浸润及浸润深度影响无临床意义.结论对于子宫内膜癌患者术前行临床分期应综合多因素评估,以提高临床分期的准确性,正确指导治疗与改善预后.     

子宫内膜癌的预后影响因素分析

背景与目的:子宫内膜癌的预后影响因素较多,但其中仅有少数因素对预后构成独立影响。本研究的目的在于探讨子宫内膜癌的独立预后影响因素。方法:对我院1990年1月至2000年12月间初治时行手术治疗的265例子宫内膜癌患者的临床资料进行回顾性研究,预后相关因素采用单因素分析及多因素相关回归分析,并进行逐步筛查。结果:本组病例的5年无瘤生存率及总生存率分别为83.3%和84.3%。单因素分析显示:临床分期、手术-病理分期、病理分级、组织学类型、肌层浸润深度、宫颈受累、淋巴结转移、腹腔液性质、脉管瘤栓及附件转移与5年无瘤生存率及总生存率有显著性相关(P<0.05),年龄、合并症因素与预后无显著性相关(P>0.05)。经多因素分析后得出,手术-病理分期、病理分级、肌层浸润深度及宫颈受累4个因素对子宫内膜癌患者的5年无瘤生存率及总生存率均产生显著性影响(P<0.05),临床分期仅对5年无瘤生存率有显著性影响(P<0.001),而对总生存率无显著性影响(P=0.074)。肌层浸润>50%者远处转移率(12.9%)明显高于≤50%者(0.6%)(P<0.001)。宫颈受累者的淋巴结转移率(21.1%)明显高于宫颈未受累者(3.6%)(P<0.001)。结论:FIGO分期、病理分级、肌层浸润深度及宫颈受累是子宫内膜癌独立的预后影响因素。在估计预后方面,手术-病理分期     

子宫内膜癌手术患者预后的相关影响因素

目的：探讨影响子宫内膜癌手术患者预后的危险因素。方法回顾性分析进行手术治疗的子宫内膜癌患者80例的临床资料。随访4年,观察影响子宫内膜癌手术患者的危险因素。结果80例子宫内膜癌手术患者随访4年后,死亡13例,死亡率16．25％。经单因素分析,年龄、组织分化程度、手术病理分期、脉管癌栓、肌层浸润深度、盆腔淋巴结对子宫内膜癌手术患者预后有一定的影响作用。经多因素Logistic回归分析,年龄≥65岁、手术病理分期、盆腔淋巴结阳性、肌层浸润深度及脉管癌栓是影响子宫内膜癌手术患者不良预后的危险因素。结论年龄≥65岁、手术病理分期、盆腔淋巴结阳性、肌层浸润深度及合并脉管癌栓是影响子宫内膜癌手术患者不良预后的危险因素。     

子宫内膜癌147例临床分析

目的：探讨子宫内膜癌的治疗及预后相关因素。方法：回顾性分析我科1991～1997年收冶的147例子宫内膜癌患者的临床病理资料，并全部随访。结果：147例患者、平均年龄56．1岁；5年生存率72．8％；临床表现不规则阴道出血135例、盆腔包块81例、白带增多38例及腹痛23例；绝经前病例为39．5％，已占相当比例，有年轻化趋势；临床病理分期愈晚，预后愈差；肌层侵犯的深度与淋巴结转移及病理组织学分级密切相关，深肌层浸润者，易淋巴结转移、病理组织学分级也差；手术为主、放疗、化疗为辅助治疗的综合治疗预后好、并发症少；孕激素对改善预后有一定的价值。结论：以手术为主的综合治疗是目前治疗子宫内膜癌的首选治疗措施；绝经前后的妇女出现不规则阴道出血等非特异性的妇科症状时，必须警惕子宫内膜癌的发生；临床病理分期、肌层浸润深度、病理组织学分级、淋巴结转移情况及孕激素的应用都是影响预后的相关因素。     

子宫内膜癌术中冰冻病理的价值探讨

目前对于子宫内膜癌患者进行全面的手术分期有争议,多数学者认为冰冻病理是唯一能术中描述子宫内膜癌组织学类型、组织学分级及肌层浸润深度的检查手段,可以指导术者决定是否进行系统的淋巴结切除,以进行全面的手术分期。术中冰冻病理的准确判断对是否行全面的手术分期具有决定性的作用。但近年来对于术中冰冻病理与术后石蜡病理的一致性存在很大的争议。本研究回顾性分析了我院手术治疗的126例子宫内膜癌患者病理资料,旨在探讨术中冰冻病理诊断子宫内膜癌组织学分级和肌层浸润深度的准确性,以评估其在子宫内膜癌全面分期手术中的指导价值。     

139例子宫内膜癌的临床分析

目的：探讨影响子宫内膜癌患者预后的因素。方法：1995年1月-2003年12月广西肿瘤医院妇瘤科收治的手术治疗的子宫内膜癌患者154例。对其中139例有完整病史资料和随访资料患者的预后因素进行回顾性分析。结果：1,3,5,8年生存率为90％,78％,69％,57％。单因素分析表明：是否绝经、手术病理期别、病理分级、组织类型、肌层浸润、ER、PR、手术方式是影响子宫内膜癌预后的相关因素;多因素回归分析表明：手术病理期别、病理分级、组织类型、肌层浸润、ER、PR是影响子宫内膜癌预后的独立因素。结论：子宫内膜癌的预后与高危因素有关。早期诊断和合理治疗能进一步改善其预后。     

子宫内膜癌bcl—2基因表达及其与PR、ER关系的研究

[目的]探讨bcl-2与子宫内膜癌发生、发展的关系以及与PR、ER在致癌过程中有无内在联系。[方法]采用免疫组化SP法检测了58例子宫内膜癌组织中bcl-2及PR、ER的表达。[结果]子宫内膜癌中bcl-2的阳性表达率为56.9%,PR、ER的阳性表达率分别为55.2%、46.6%。bcl-2的阳性表达与组织学分级有关,而与其他临床病理学特征无关;PR的阳性表达与子宫内膜癌的临床病理特征都有关;ER的阳性表达只与肌层浸润深度有关,bcl-2的阳性表达与PR呈现正相关。[结论]bcl-2可能与子宫内膜癌的发生和分化特性有关;PR可能在子宫内膜癌的发生、发展中起作用。     

Analysis of residual disease following preoperative radiotherapy versus initial surgery in endometrial carcinoma

A clinicopathologic study of residual disease following pre-operative radiotherapy (RT) in 67 patients and initial surgery in 40 patients with early invasive endometrial carcinoma is presented. In 10%, extrauterine spread was found at operation. In 10% of patients, the histologic type, and in 19% the grade of tumor, differed between the curettage and hysterectomy specimens. Pre-op RT altered the depth of myometrial invasion and frequency of vascular invasion, but there was no evidence that irradiation itself affected the histologic type or grade of tumor. The patients with residual tumor after pre-op RT had significantly more cancer-related deaths than those without residual disease. The high risk factors were deep myometrial invasion and residual disease outside the uterus. Vascular invasion did not affect the prognosis in this series. The importance of surgical-pathologic staging by initial surgery is discussed.     

MRI灌注、PTEN蛋白表达对子宫内膜癌肌层侵犯的评估

目的探讨F＇TEN蛋白表达与子宫内膜癌发生、发展的关系。方法对32例子宫内膜癌患者,术前1周内行MRI（核磁共振）灌注检查、PTEN（第十染色体同源丢失性磷酸酶-张力蛋白基因）蛋白表达测定。MRt灌注检查采用超导磁共振仪体线圈,通过灌注Gd—DTPA代谢像了解子宫内膜癌肌层浸润深度。经诊刮证实为子宫内膜癌患者的子宫内膜癌组织,采用链霉素抗生素蛋白-过氧化物酶（SP）法检测PTEN表达。结果在32例子宫内膜癌患者中,MRI灌注检查无肌层浸润和浅肌层浸润17例,深肌层浸润15例。PTEN蛋白表达检测：阳性表达14例,阴性表达18例;术后病理检查证实无肌层浸润和浅肌层浸润17例,深肌层浸润15例。MRI灌注检查准确度为90．48％,其中在特殊类型癌中PrEN蛋白表达缺失率为83．33％,Ⅳ期患者PTEN蛋白表达缺失率为100．00％。G12、G3级患者PTEN蛋白表达缺失率为65．22％（P〈0．05）。深肌层浸润患者中PTEN蛋白表达缺失率为73．33％（P〈0．05）。结论MRI灌注对术前子宫内膜癌肌层侵犯深度的检测准确性优于PTEN蛋白表达。PTEN蛋白表达缺失与子宫内膜癌的发生和发展,组织学类型、手术病理分期、组织学分级、肌层浸润深度密切相关。     

Comparison of Myometrial Invasion and Tumor Free Distance from Uterine Serosa in Endometrial Cancer

Background: We aimed to investigate whether the tumor free distance (the distance between the uterineserosa and the tumor at its deepest point) is useful in surgical staging and in predicting prognosis. Materialsand Methods: Data from patients who underwent complete surgical staging for endometrial cancer betweenJanuary 2006 and June 2011 were reviewed retrospectively. All demographic findings, surgical stages, histologicaltype and grade, myometrial invasion, lymphovascular space invasion as well as abdominal cytology, cervical,adnexal, and omental involvement, and lymph node metastasis were recorded. The relations between myometrialinvasion and tumor free distance from uterine serosa with prognostic factors were investigated. Results: Seventypatients were included in the study. Sixty-four (91.5%) had endometrioid type cancers and forty-four (62.9%)were grade 1. The deepest myometrial invasion was less than 1/2 in 42 patients (60%). In 18 patients (25.8%)lymphovascular invasion was noted. Eight (11.4%) were found to have cervical involvement, five (7.1%) hadadnexal involvement and in 4 cases (5.7%) the peritoneal washings included malignant cells. Four patients hadpelvic and one para-aortic node metastasis. We recognized that an invasion of more than 1/2 was correlatedsignificantly with lymphovascular space involvement, histological grade, positive abdominal washing cytology,nodal and cervical involvement, but not with adnexal involvement. Tumor-free myometrial thickness wasnegative and statistically significant correlated with surgical stage, histological grade, lymphovascular spaceinvolvement, positive abdominal washing cytology, cervical and adnexal involvement. The importance of tumorfreemyometrial thickness in determinating the lymphovascular space invasion was found to be highest in termsof sensitivity and specificity when crossing the ROC curve at 11 millimeters. Conclusions: Depth of myometrialinvasion is more valuable for predicting lymph node metastasis than tumor-free myometrial thickness. Thetumor-free myometrial thickness provides a better prediction for adnexal involvement.     

Evaluation of the Accuracy of Preoperative MRI in Measuring Myometrial Infiltration in Endometrial Carcinoma

The aim of our study was to evaluate the diagnostic performance of magnetic resonance imaging (MRI) in the pretreatment evaluation of myometrium invasion in endometrial cancer. Our retrospective study concerns 89 patients with endometrial cancer, who had preoperative MR evaluation of myometrium invasion and we compared it with histological results. Considering histological type and grade, we had excluded patients with poor prognosis, and separately evaluated those cases where the depth of myometrium invasion is the main prognostic factor determining the choice treatment. Of the 89 cases MRI had accurately evaluated the depth of myometrial invasion in 75 patients. Based on data from all cases, we found the sensitivity of detection of deep myometrial infiltration by MRI (Sv) 71 %, specificity (Sp) 92 %, accuracy (Acc) 84 %, positive predictive value (PPV) 86 % and negative predictive value (NPV) 83 %. Excluding patients with poor prognosis according to histology and grade, these data were Sv 71 %, Sp 95 %, Acc 87 %, PPV 90 %, NPV 84 %. In conclusion, MRI is an efficient diagnostic tool in assessing myometrial infiltration, which is necessary for proper preoperative staging and therapy planning, including evaluation of the necessity of lymphadenectomy. Certain factors may interfere with evaluation of MRI results, thus hindering the precise determination of the level of myometrial infiltration.     

子宫内膜癌治疗方法对预后影响因素的探讨

Objective： To investigate the relative factors in the prognosis of endometrial cancer. Methods： From 1991 to 1999, 125 patients with endometrial cancer were treated in our hospital. Among them, 96 cases were received operation. Their clinical and pathological data were analyzed retrospectively. Results： The overall survival rate at 5-year were 77.6%, stage I to stage IV were 85.9%, 68.8%, 53.8% and 0%, respectively. The survival rates at 5-year in histological grade 1, grade 2 and grade 3 were 100%, 77.1% and 38.1% respectively. There＇s no significant difference between grade 1 and grade 2 （P 〉 0.05）. As to grade 1 and grade 3, grade 2 and grade 3, there were significant differences （P 〈 0.05）. The survival rate was 100% in patients with endometrium or superficial myometrial invasion and 35.3% in cases of deeper invasion （P 〈 0.01）. Conclusion： Therapy based on operation is presently accepted as the first line management of endometrial cancer. Clinical stage, histological grade, depth of myometrial invasion and lymph node metastasis are relative factors of prognosis.     

磁共振成像在子宫内膜癌术前分期及肌层浸润深度判定中的作用（依照新修订的FIGO分期系统）

目的：评价在新修订的FIGO分期系统下,磁共振成像（magnetic resonance imaging,MRI）在子宫内膜癌术前分期及肌层浸润深度判定中的作用。方法：对36例子宫内膜癌进行术前MRI分期和肌层浸润深度判定,并与手术病理分期对照。结果：MRI术前分期诊断准确率为91.7%（33/36）。MRI诊断无肌层侵犯、浅肌层侵犯和深肌层侵犯的敏感性、特异性、准确率分别为50%、85.7%、77.8%;84.4%、76.5%、80.6%;80.0%、100%、94.4%。MRI区分Ⅰa期（无肌层侵犯和浅肌层侵犯）和Ⅰb期（深肌层浸润）的诊断准确率为94.4%（34/36）。结论：MRI对子宫内膜癌术前分期及肌层浸润深度的判断准确率较高,具有很高的应用价值。     

子宫内膜透明细胞癌69例预后因素分析

[目的]探讨子宫内膜透明细胞癌的预后因素。[方法]回顾性分析69例原发性子宫内膜透明细胞癌患者的临床资料。[结果]术前诊刮准确率为69.8%。临床分期、宫颈受累、累及附件、宫外转移、腹水细胞学、脉管间隙受侵、治疗方式及复发与患者预后相关（P〈0.05）。Cox回归分析显示腹水细胞学、脉管间隙受侵、治疗方式及复发情况是影响子宫内膜透明细胞癌患者预后的独立危险因素。[结论]子宫内膜透明细胞癌诊刮准确率低。腹水细胞学、脉管间隙受侵、治疗方式及复发与否是影响子宫内膜透明细胞癌患者生存率的独立危险因素。