子宫内膜癌临床及预后因素分析

目的搜集我院15年间收治的子宫内膜癌患者的临床、病理及随访资料,分析子宫内膜癌临床病理特点及预后相关因素。方法对我院1991~2005年间,收治住院有完整资料的150例子宫内膜癌患者的临床、病理资料进行回顾性分析并进行随访。结果(1)患者年龄为30~80岁,平均年龄55.1岁±8.6岁;≤45岁者20例(13.3%),平均年龄37.2岁±6.0岁。其中,2000~2005年18例(17.0%)与1991~1999年2例(4.5%)资料相比,患者年龄有年轻化趋势(P<0.05)。临床表现以绝经后阴道流血最多,其次为绝经前月经量增多或不规则阴道流血分别占69.2%、30.8%。(2)绝经前患者确诊时间迟于绝经后患者(P<0.01);年龄与确诊时间有显著性相关(rs=0.290,P<0.05)。(3)术前B超检查在癌浸润深度上诊断符合率:无肌层浸润为40.9%、肌层浸润≤1/2为42.0%,与术后病理检查相比有统计学意义(P<0.05);肌层浸润>1/2为84.0%,两者相比无统计学意义(P>0.05)。(4)生存分析:①年龄、绝经与否5年生存率无显著性差异;②病理类型、肌层浸润、组织学分级、手术-病理分期预后,有统计学意义(P<0.05)。(5)上述单因素分析结果有意义的预后因素,经Cox比例风险回归分析显示:病理类型、手术-病理分期、肌层浸润深度和组织学分级,是影响患者预后的独立危险因素。结论(1)子宫内膜癌发病呈逐年上升趋势,发病年龄有年轻化趋势。绝经前妇女一旦出现月经紊乱及其相关临床表现时,应首先排除子宫内膜癌。(2)较年轻的患者出现症状后到确诊的时间亦较长。(3)经多因素分析,病理类型、手术-病理分期、肌层浸润深度及组织学分级是子宫内膜癌的独立预后因素;年龄、绝经与否无显著的独立预后意义。(4)手术-病理I、II、III期5年生存率,分别为88.5%、72.9%、48.6%,IV期3年生存率为33.3%,5年生存率为0%。(5)B超检查对判断癌浸润深度(肌层受浸>1/2时)有一定价值。

Endometrial Carcinoma and Prognostic Factors Analysis

Objective To summarize clinicopathologic features, treatment and follow - up information of patients with endometrial carcinoma （EC） in our hospital in recent 15 years. To investigate changes in clinical and pathological characteristics of patients with EC, and to identify parameters predicting the prognosis in EC. Methods Clinical and pathological information of 150 patients with EC treated in our hospital from Jan. 1991 to Dee. 2005 were reviewed. And eighty six percent of all patients were followed up for a period varies from 6 to 168 months. Survival rate were calculated using Kaplan - Meier method, and prognosis parameters were analyzed using Log - rank test and Cox＇ s proportional haz- ard regression. Results （ 1 ） The mean age of the 150 EC patients was 55.1 ± 8.6 years old. 13.3 percent of them are younger than 45 years old, which accounted for a significantly larger proportion compared with data from from Jan. 1991 to Dee. 2000 in our hospital （ P 〈 0.05）. （2） The definite time is later in the premenopausal patients than the post- menopausal ones （ P 〈 0.01）; age and the definite time is correlated using speammn＇ s rank correlation （r2 = 0.290, P 〈 0.05）. （3） The correspondence rates of preoperative B - Ultrasongraphy in judging the myometrial invasive depth were 40.9%, 42.0% and 84.0% in diseases with no myometrial invasion, invasive depth ≤ 1/2, and invasive depth 〉 1/2, respectively, showing a significant difference from the results of postoperative patholOgical examinations for diseases with no invasion or invasive depth≤ 1/2（ P 〈 0.05）, but not for diseases with invasive depth 〉 1/2（ P 〉 0.05）. （4） Results of Log- rank test： （1）the 5 - year survival rate of age/menopanse is not（ P 〉 0.05）. （2）histologic type, histo- logic grade, depth of myometrial invasion and surgical - pathological stage, all of which have significant difference （ P 〈 0.05）. （3） Significant prognostic factors in Log- rank test above were analyzed by Cox＇s proportional hazard regression and It indicated that histologic type, surgical - pathological stage, histologic grade, and depth of myometrial inva- sion had independent prognostic significance in EC. Conclusion （1） The mobidity of EC has an increasing tendency year by year, and In recent years, women with EC are younger and younger. Premenopausal women who had menoxenia or hypermenorrhea should exclude the possibility of EC in the first place, and if diagnosed at early stage, they had a favorable prognosis. （2）The time from the appearance of abnormal symptoms to the definite diagnosis is much more longer in the younger patients. （3）Multiple - factor analysis indicated that surgical - pathological stage, histologic type, histo- logic grade and depth of myometrial invasion had independent prognostic significance in patients with EC whereas age, menopause did not have. （4） The 5 - year survival rate of surgical staging I, Ⅱ and Ⅲ were 88.5 %, 72.9% and 48.6% respectively and 3 - year survival rate in stage Ⅳwas 33.3%. （5） B - Urtrasongraphy has its value in judging the invasive depth for disease with invasive depths〉 1/2. Key words： Endometrial carcinoma; Clinicopathologic ; Follow - up; Prognosis