子宫峡部内膜癌的临床病理特征及预后

目的分析子宫峡部内膜癌的临床病理特点及预后相关因素。方法对天津医科大学总医院1980年1月至2005年12月收治的349例子宫内膜癌,按肿瘤部位分为峡部内膜癌（UIE）组与非峡部内膜癌组,比较两组临床病理特征及预后。结果UIE占10.0%（35/349）。与非峡部内膜癌相比,UIE组阴道排液及腹痛的比例较高（P〈0.05）。UIE组更容易发生深肌层浸润、宫颈侵犯、脉管浸润、浆膜受累、腹腔细胞学阳性以及盆/腹腔淋巴结转移,临床分期、手术病理分期较高（P均〈0.05）,具有较低的5年生存率（P〈0.05）。多因素分析显示峡部癌灶并非是预后不良的独立性相关因素。结论子宫峡部内膜癌具有特殊的临床病理特征,其可增强其他预后不良因素的作用而影响预后。

Clinicopathologic features and prognostic factors of uterine isthmic endometrial carcinoma

Objective To analyze the clinicopathologic characteristics and prognostic factors of uterine isthmic endometrial carcinoma(UIE).Methods A total of 349 endometrial carcinoma cases were divided into the UIE group,whose primary cancer involved the uterine isthmus,and the control group whose primary cancer involved the other sites of the uterus.The clinicopathological features and outcome were compared.Results The incidence of UIE was 10.0%(35/349).In the UIE group,the incidences of vaginal discharge and abdominal pain were higher(all P<0.05).The rate of low grade,deep myometrial invasion,cervix invasion,lymph-vascular invasion,serous invasion,positive peritoneal cytology and lymph node metastasis was higher in the UIE group,with higher clinical stage and surgical-pathologic stage(all P<0.05).The 5-year survival rate in UIE group was lower(P<0.05).Isthmus location was correlated with 5-year survival rate by univariate analysis.Conclusion The patients with endometrial cancer of the uterine isthmus have distinctive clinicopathologic features.The isthmus location can amplify other adverse factors affecting the prognosis of endometrial carcinoma.