老年子宫内膜癌患者临床病理分析及孕激素治疗对预后的作用

目的 回顾性分析老年子宫内膜癌患者临床病理特征与孕激素治疗的预后. 方法 235例子宫内膜癌患者按年龄分3组:30～49岁组54例、50～59岁组102例和60～82岁组79例,分析年龄与影响患者预后的临床病理因素间的关系,并随访60～82岁组患者行孕激素治疗的预后.结果 随增龄,特殊病理类型(浆液性乳头状囊腺癌、透明细胞癌、鳞癌)、手术病理分期三期及以上和低分化子宫内膜癌发生率升高,其中特殊病理类型30～49岁组、50～59岁组和60～82岁组分别为20.4%(11/54)、38.2%(39/63)、48.1%(38/79),3组间比较差异有统计学意义(χ2=10.039,P<0.01),而孕激素受体阳性表达率明显降低分别为57.4%(31/54)、45.1%(46/102)、25.3%(20/79),P<0.01];术后行孕激素治疗(23例)缓解率78.3%(18例),高于放疗和(或)化疗(8例)的缓解率50.0%(4例),差异有统计学意义(Z=1.46,P<0.05). 结论 子宫内膜癌患者随年龄增大,与预后差相关的临床病理因素发生率增高,60～82岁组孕激素治疗预后好于放疗和(或)化疗.

The analysis of clinicopathological features and of progesteron effect on prognosis in elderly patients with endometrial carcinoma

Objective To retrospectively analyze clinicopathological features and prognosis effect of progesterone therapy in elderly patients with endometrial carcinoma. Methods Two hundred and thirty-five patients were divided into three groups according to age: 30-49 years old group (n=54), 50-59 years old group (n= 102) and 60-82 years old group (n= 79). The relationship between age and clinicopathological features was analyzed, and the prognosis effect of progesterone therapy in patients of 60-82 years old was assesed. Results The incidences of special pathological type of endometrial cancer (serous eystadenocarcinoma, clear cell carcinoma and squamous cell carcinoma) , operation-pathological stage ≥Ⅲ and low differentiation were increased with advancing age. The incidences of the above mentioned special pathological type of endometrial cancer were 20.4% (11/54), 38. 2%(39/63), 48.1%(38/79) in the three groups, respectively, and there were statistical significances among the three groups (χ<'2> = 10.039, P<0.01). The positive rate of progesterone receptor was significantly decreased in the three groups (57.4% (31/54)vs. 45.1% (46/ 102) vs. 25.3%(20/79), P<0. 01]. The remission rate of progesterone therapy was higher (18/23) than that of radiotherapy and (or) chemotherapy (4/8) (78.3% vs. 50%, Z= 1.46, P<0. 05). Conclusions The incidence of clinical pathological factors of endometrial cancer is increased with advancing age, and the prognosis of progesterone therapy is better than treatment with radiotherapy and (or) chemotherapy.