未绝经妇女子宫内膜癌的临床病理特征及预后

目的：分析未绝经妇女子宫内膜癌的临床病理特征及预后。方法：分析349例内膜癌患者临床资料，按绝经状态分为未绝经组（41．5％）与绝经后组（58．5％），比较2组临床病理特征及预后。结果：未绝经组合并肥胖、高血压、糖尿病的比例低于绝经后组（24．8％vs36．8％，24．1％vs52．0％，17．9％vs27．9％，均P〈0．05），但未绝经组合并不孕、多囊卵巢综合征（PCOS）、肿瘤家族史及内膜增生的比例较高（均P〈0．05）。绝经后妇女以阴道排液为主诉的比例较高（P〈0．01）。2组均以内膜样腺癌为主要病理类型，但未绝经患者组织分化较好，深肌层浸润及腹腔细胞学阳性比例低于绝经后组（均P〈0．01）。未绝经组的5年生存率为91．71％，高于绝经后组的71．92％（P〈0．05）。多因素分析显示绝经状态、宫颈侵犯、淋巴结转移、浆膜受累、特殊病理类型及组织低分化是影响内膜癌预后的独立性相关因素。结论：绝经前、后子宫内膜癌的临床病理特征存在差异，未绝经患者预后较好。

Clinicopathologic Features and Prognosis of Endometrial Carcinoma in Pre-menopausal Women

Objective: To analyze the clinicopathologic characteristics and prognosis of endometrial carcinoma (EC) in pre-menopausal women. Methods: Three hundred and forty-nine EC patients were divided into two groups based on menopausal status. The incidence of pre-menopause was 41.5%, and that of post-menopause was 58.5%. The clinicopathological features and outcome were compared between these two groups.Prognostic factors of EC were evaluated by multivariate analysis. Results: The incidence of obesity, hypertension, diabetes mellitus in pre-menopausal patients were lower than those in postmenopausal group (24.8% vs 36.8%, 24.1% vs 52.0%, and 17.9% vs 27.9% respectively, P < 0.05). The incidence of infertility, polycystic ovary syndrome (PCOS), tumor family history and endometrial hyperplasia were higher in pre-menopausal group (P < 0.05). Vaginal discharge was more frequent in post-menopausal women (P < 0.01). Endometrioid carcinoma was the main histological type in these two groups. But the pathologic grade, depth of myometrial invasion, peritoneal cytology were significant different (P <0.01). The 5-year survival rate in pre-menopausal patients was higher than that in postmenopausal women (91.71% vs 71.92%, P< 0.05). On multivariate analysis, menopausal status, cervix invasion, lymph node metastasis, serous invasion, histological type and pathologic grade were independent prognostic factors of endometrial cancer. Conclusion: The clinicopathologic features of endometrial carcinoma in pre-menopausal women are different from that in postmenopausal patients. Pre-menopausal patients have better prognosis.