225例子宫内膜癌患者生存预后相关因素的分析

目的：探讨子宫内膜癌的预后及其相关因素，为子宫内膜癌的临床诊治提供参考。方法：回顾性分析2003年1月—2010年6月北京协和医院妇产科收治的225例子宫内膜癌患者的临床资料，计算生存率，Kaplan-Meier法筛选危险因素，用比例危险度回归模型（Cox回归）对危险因素进行多因素分析。结果：225例患者5年累积生存率为90.6%。单因素Kaplan-Meier分析显示，子宫内膜癌生存率与手术病理分期、组织学分级、肌层浸润深度、病理类型、术后辅助治疗、淋巴结转移和腹腔细胞学有关（P＜0.05）。各手术分期患者中，行淋巴结剔除者和未行淋巴结剔除者的生存率差异无统计学意义（P＞0.05）。早期子宫内膜癌患者术后接受辅助治疗和未接受辅助治疗的患者生存率差异无统计学意义（P＞0.05）。Cox回归行多因素分析显示，手术分期、病理类型、组织学分级是影响子宫内膜癌预后的独立危险因素（P＜0.05），非子宫内膜样癌、手术病理分期晚和组织学分级差的患者预后差。结论：子宫内膜癌总体预后良好，手术分期晚、非子宫内膜样癌、组织学分级差是子宫内膜癌预后的独立危险因素，肌层浸润深度、腹腔冲洗液等与其预后无关。

A Prognostic Analysis of 225 Cases of Endometrial Carcinoma

Objective:To explore the factors related to prognosis of endometrial carcinoma, so as to improve accordingly clinical treatment. Methods:All the clinical data of 225 cases of endometrial carcinoma, from January 2003 to June 2010, was analyzed. The Kaplan-Meier test and multivariate Proportional hazards regression model (Cox regression) were used for finding those risk factors related to the prognosis of endometrial carcinoma. Results:The overall 5-year survival rate was 90.6%. The Kaplan-Meier test suggested that the FIGO surgical stage, histological grade, depth of myometrial invasion, pathological type, postoperative adjuvant therapy, lymph node metastasis and peritoneal cytology be related to the survival rate (P<0.05). There was not significant difference in the survival rate between patients with and without the lymphatic nodes removed (P>0.05). Interestingly, there was not significant difference in the survival rate between those early stage patients with and without adjuvant therapy (P>0.05). The Cox regression showed that the pathological type, FIGO surgical stage and histological grade were the independent risk factors of the prognosis of endometrial carcinoma (P<0.05), and that the prognosis of those patients with the late pathological stage and poor histological grade was dissatisfactory. Conclusions:The overall 5-year survival rate of endometrial carcinoma was satisfactory. The pathological type, FIGO surgical stage and histological grade are the independent predictive factors for the prognosis of endometrial carcinoma. Meanwhile, the depth of myometrial invasion and the peritoneal cytology are not related to the prognosis of endometrial carcinoma.