45岁以下子宫内膜癌患者的临床分析

目的　总结 45岁以下子宫内膜癌患者的临床特点。方法　回顾性分析北京协和医院52例 45岁以下子宫内膜癌患者的临床资料 ,并将其分为≤ 3 5岁年龄组 (A组 ,17例 )与 3 5～ 45岁年龄组 (B组 ,3 5例 )进行比较分析。结果　 45岁以下内膜癌患者占内膜癌总数的 12 7% ,随年龄的增加 ,发病人数有增加的趋势 ,约 50 %的患者合并未产、不育、月经失调、子宫内膜增生 ,2 9%合并肥胖 ,2 3 %合并多囊卵巢 ,其中A组合并多囊卵巢的比例为 53 % ,合并内膜不典型增生的比例为 59% ,较B组明显增高 (分别为 9%、2 6% ) ,差异有显著性 (P <0 0 5)。按国际妇产科联盟 (FIGO)标准手术病理分期Ⅰ期占 82 % ,其中A组均为Ⅰ期子宫内膜样腺癌 ;B组有高危因素的患者比例占 2 6% ,但除了分期有升高的趋势 (P <0 0 5)外 ,其余差异均无显著性 (P >0 0 5)。治疗以手术为主 ,另有 2例患者采用孕激素治疗保留生育功能 ,获得缓解。 2例复发。结论　 45岁以下子宫内膜癌患者多合并不育、月经失调、内膜增生、肥胖、多囊卵巢 ,表明其发生与雌激素有关 ;期别以Ⅰ期为主 ,尤其是≤ 3 5岁者 ,高危因素少 ,预后较好。对于早期 (Ⅰa期 ) 45岁以下内膜癌患者可考虑保留生育功能或卵巢

Clinical analysis of endometrial carcinoma patients aged 45 years and younger

OBJECTIVE: To retrospectively analyze the clinical characteristics and outcomes of endometrial carcinoma patients aged 45 years and younger. METHODS: Fifty-two cases of endometrial carcinoma aged 45 years and younger were treated in Peking Union Medical College Hospital. They were further divided into group A (35 years of age and younger) and group B (older than 35 years). Clinical data of these patients were reviewed and the two groups were compared. RESULTS: Patients aged 45 years and younger accounted for 12.7% of all the endometrial carcinoma cases. About 50% of the patients were nulliparous, infertile or had irregular menstruation and endometrial hyperplasia, 29% were obese, 23% had polycystic ovaries. Eighty-three percent of the patients were stage International Federation of Gynecology and Obstetrics (FIGO), 1988]. Group A had more polycystic ovaries and atypical endometrial hyperplasia than group B (53% vs 9%, 59% vs 26% respectively, P < 0.05). All group A patients were stage I endometrial carcinoma. In group B, 26% had high risk factors, and compared with group A, FIGO stage was higher (P < 0.05). Operation was the main treatment. Two patients were treated successfully with conservative high dose progestin. Two patients relapsed. CONCLUSIONS: There were high incidences of infertility, irregular menstruation, endometrial hyperplasia, obese and polycystic ovaries in patients aged 45 years and younger, indicating the relationship between endometrial carcinoma and estrogen. Most patients, especially those younger than 35 years, were stage I with few risk factors and good prognosis. Conservation of fertility and ovarian function should be considered in these patients.