子宫内膜和卵巢双原发癌43例临床与预后分析

目的 探讨子宫内膜和卵巢双原发癌的临床病理特点、治疗方法及其预后.方法 回顾性分析43例子宫内膜和卵巢双原发癌的临床病理资料、治疗方法、生存情况及其预后.结果 43例患者的年龄为28～73岁,中位年龄49岁.主要症状为不规则阴道出血和盆腹腔疼痛.查体发现盆腹腔肿物17例(39.5%),子宫增大12例(27.9%).所有患者均行超声检查,超声发现盆腔肿瘤29例(67.4%),子宫内膜增厚或异常回声10例(23.3%).行CT或MRI检查的25例患者中,子宫增大11例(44.0%),盆腔肿瘤13例(52.0%),1例未见异常.15例患者分段取内膜活检,病理均诊断为子宫内膜癌.行CA125检查的34例患者中,22例(64.7%)CA125值升高,中位值为500 U/ml,平均为812.9 U/ml.31例患者接受全子宫双附件、大网膜及阑尾切除术;12例患者同时接受了盆腔淋巴结清扫术.以内膜样腺癌为主的子宫内膜癌38例(88.4%),卵巢癌中内膜样腺癌或含内膜样腺癌成分的混合癌患者30例(69.8%).子宫内膜癌中,ⅠA期18例,ⅠB期20例,ⅠC期2例,ⅡA期3例;卵巢癌中,ⅠA期19例,ⅠB期4例,ⅠC期7例,Ⅱ期4例,ⅢC期9例.子宫内膜癌与卵巢癌均早期(均为Ⅰ期)患者24例,占55.8%.术后接受化疗26例(60.5%),接受化疗联合放疗12例(27.9%),单纯放射治疗1例.43例患者总的3年和5年生存率分别为87.4%和71.1%.子宫内膜与卵巢肿瘤均为内膜样腺癌患者的3年和5年生存率分别为93.8%和82.0%;子宫内膜与卵巢肿瘤不均是内膜样癌患者分别为79.7%和69.0%.子宫内膜癌与卵巢癌早期患者的3年和5年生存率分别为93.3%和93.3%,明显高于非早期患者(69.7%和36.7%,P=0.0002).患者治疗后复发15例,复发率为34.9%.单因素分析显示,CA125值升高、手术病理分期、化疗联合放疗对预后有显著影响.多因素分析显示,分期、化疗联合放疗对患者预后有显著影响.结论 子宫内膜和卵巢双原发癌患者多为早期,病理分化较好,多数患者预后较好,监测患者CA125水平的意义值得进一步研究.早期患者可行全子宫双附件和大网膜切除,但淋巴结清扫的意义尚不能肯定;晚期患者术后可行化疗联合放疗.

Synchronous primary cancers of the endometrium and ovary: review of 43 cases

Objective To investigate the clinical and pathological characteristics, treatment methods, and prognosis of synchronous primary cancers of the endometrium and ovary. Methods The clinical data of 43 patients with synchronous primary cancers of the endometfium and ovary were retrospectively reviewed. The survival was calculated by Kaplan-Meier method and compared using the log-rank test. Results The median age at diagnosis was 49 years (range, 28-73 years). The most common symptoms were abnormal vaginal bleeding (69.8%) and abdominal or pelvic pain (44.2%). Pelvic masses were found in 39.5% of the patients and enlarged corpus in 27.9% at physical examination, while pelvic masses were found in 67.4% of the 43 patients (29 cases) and thickening or abnormal endometrium in 23.3% (10 cases) during ultrasound examination. Of 25 patients examined by CT/MRI, pelvic masses were found in 13 cases and enlarged uterus in 11 cases. All 15 patients who underwent endometrial biopsies were proven to have endometrial carcinomas. Serum CA125 level was found to be elevated in 22 of the 34 examined cases (64.7%) with a median value of 500 U/ml (range, 39-3439 U/ml). FIGO stages of endometriai carcinomas: ⅠA 18 cases, ⅠB 20 cases, ⅠC 2 cases, Ⅱ A 3 cases; Stages of ovariancarcinomas: ⅠA 19 cases, ⅠB4 eases, ⅠC 7 cases, Ⅱ 4 cases, ⅢC 9 cases. Twenty-four patients(55.8%) were in stage Ⅰ both endometrial and ovarian carcinomas. Thirty-one patients underwent total hysterectomy plus biLateral salpingo-oophorectomy with omentectomy and appendectomy, meanwhile, 12 patients had pelvic lymph node dissection. Thirty-eight of the 43 patients (88.4%) had a pathologically proven endometrial adenocarcinoma. The predominant ovarian histology was endometrioid or mixed tumor with endometrioid components (30/43, 69.8%). Postoperatively, 26 patients (60.5%) received adjuvant chemotherapy alone, 12 had chemotherapy plus radiotherapy, only one patient had radiation alone and the remaining 4 cases received no adjuvant treatment. The 3- and 5-year survival rates of the group were 87.4% and 71.1%, respectively. The 3- and 5-year survival rates of patients with both endometrioid and ovarian carcinomas were higher than that of those with non-endometrioid or mixed subtypes (93.8%, 82.0% vs. 79.7%, 69.0%). The 3-year and 5-year survival rates of patients with early stage disease were better than those of the other patients (93.3%, 93.3% vs. 69.7%, 36.7%). Recurrence developed in 15 patients (34.9%). It was showed by univariate analysis that lower CA125 level, early FIGO stage, and adjuvant chemotherapy plus radiotherapy significantly and positively affect the 5-year survival rates, while only early FIGO stage and chemotherapy plus radiotherapy were revealed by multivariate analysis as independent prognostic factors. Conclusion Synchronous primary cancers of the endometrium and ovary are different from either primary endometrial carcinoma or ovarian cancer, while it can usually be detected in early stage and with a good prognosis. The impact of the CA125 level on prognosis needs to be further studied. Surgical treatment alone may be enough for early stage patients. Chemotherapy plus radiotherapy may be necessary for advanced stage patients.