子宫内膜腺癌伴鳞状上皮分化的临床特征及预后

目的:探讨子宫内膜腺癌伴鳞状上皮分化的临床病理特征及预后。方法:收集1999年3月至2013年2月汕头大学医学院附属肿瘤医院收治的子宫内膜腺癌伴鳞状上皮分化54例的临床资料进行回顾性分析。结果:54例患者诊断时中位年龄55岁，临床症状表现为绝经后阴道出血或月经紊乱。49例患者术前子宫分段诊刮术病理示子宫内膜腺癌、子宫内膜腺鳞癌或子宫内膜腺棘癌。按FIGO分期（2009年），Ⅰa期27例，Ⅰb期7例，Ⅱ期7例，Ⅲa期3例，Ⅲb期2例，Ⅲc1期5例，Ⅲc2期2例，Ⅳb期1例。3年生存率82.2%。单因素分析结果显示患者总生存时间（OS）与FIGO分期、腹膜后淋巴结转移、卵巢转移、术后放疗和/或化疗有关（P均＜0.05）。结论:FIGO分期、卵巢转移、腹膜后淋巴结转移、术后放疗和/或化疗是影响子宫内膜腺癌伴鳞状上皮分化患者预后的危险因素，早期诊断及早期接受治疗可改善其预后，对于手术后病理存在高危因素的患者，术后补充以铂类为基础的联合化疗和/或盆腔外照射，可改善预后。

Clinicopathological characteristics and prognosis of endometrial adenocarcinoma with squamous cell differentiation

Objective：To evaluate the clinicopathological characteristics and prognosis of endometrial adenocarci-noma with squamous cell differentiation. Methods：The clinical,pathologic and follow-up data of 54 cases with endo-metrial adenocarcinoma with squamous cell differentiation treated in Cancer Hospital of Shantou University Medical College from 1999 to 2013 were analyzed retrospectively. Results：All 54 patients with endometrial adenocarcinoma with squamous cell differentiation had a median age of 55 years at diagnosis. Most of the patients had the symptoms of postmenopausal vaginal bleeding or menstrual disorders. The pathologic results of uterine segment diagnostic curettage were adenocarcinoma,adeno-squamous carcinoma and adenoacanthoma of endometrium in 49 cases. The number of patients with FIGO stage（2009）Ⅰa ,Ⅰb ,Ⅱ,Ⅲa ,Ⅲb ,Ⅲc1 ,Ⅲc2 ,Ⅳb was 27,7,7,3,2,5,2,1 respectively. The 3-year survival rate of the patients was 82. 2%. The result of single-factor analysis showed that FIGO stage,ovarian metastasis,retroperitoneal lymph node metastasis,radiotherapy and/or chemotherapy after surgery were the correlative factors of overall survival（ OS）. Conclusion：Ovarian metastasis,retroperitoneal lymph node metastasis,radiotherapy and/or chemotherapy after surgery were the important prognostic factors of endometrial adenocarcinoma with squamous cell differentiation. Early diagnosis and early treatment can improve the prognosis. For the patients with pathological risk factors,combination chemotherapy based on platinum and/or pelvic radiotherapy after surgery can lead to a better prognosis.