子宫内膜腺鳞癌患者预后的多因素分析

Multivariate analysis for prognostic predictors in endometrial adenosquamous carcinoma

目的 :探讨影响子宫内膜腺鳞癌预后的相关因素 ,并划分高危人群。方法 :收集中山大学肿瘤防治中心 1980年 1月 1日～ 1999年 12月 3 1日收治以手术或手术为主综合治疗的子宫内膜腺鳞癌患者 78例。应用Cox多因素模型分析预后影响因素 ,建立预后指数 (prognosticindex ,PI)方程 ,根据预后指数将患者分为不同的危险组 ,计算不同危险组的期望生存曲线。结果 :患者 5年生存率为 61 1% ,多因素分析结果显示手术病理分期 (FIGO分期 )、病理分级、肿瘤浸润深度是影响预后的主要危险因素 ,P <0 0 5。预后指数PI =1 0 89(FIGO分期 ) +0 970 (病理分级 ) +1 3 67(浸润深度 )。根据PI值将患者划分为低危组、中危组和高危组 ,3组患者的 5年生存率分别为10 0 %、77 74%、0 ,P <0 0 0 1。 3组的 5年生存率两两之间差异有统计学意义 ,P <0 0 5。结论 :手术病理分期、肿瘤病理分级和肿瘤浸润深度是影响子宫内膜腺鳞癌患者预后的主要因素 ;PI值计算简单 ,可根据PI值对患者进行合理化分层 ,为临床个体化治疗和预测预后提供参考。

OBJECTIVE:To explore the prognostic factors of endometrial adenosquamous carcinoma and to identify the risk population.METHODS:Cox regression model was used to analyze 78 cases of endometrial adenosquamous carcinoma treated by surgery alone or surgery based comprehensive treatment in the Cancer Center,Sun Yat-sen University from 1st Jan.1980 to 31st Nov.1999.The prognostic index (PI) of patients was calculated on basis of the multivariate analysis.With the individual PI,patients were classified into different risk groups and the expected survival curves were obtained.RESULTS:Overall 5 years survival rate was 61.1%.Multivariate analysis revealed that the pathological FIGO stage,differential grade and myoinvasion depth were independent factors for overall survival rate,P<0.05.PI=1.089(FIGO stage)+0.970(differentiation grade)+1.376(myoinvasion depth).The patients were divided into low-risk group,moderate-risk group and high-risk group according to the PI value and there was significant difference in survival rate between each two ones of the three groups,P<0.05,and the 5-year survival rate was 100%,77.74% and 0%,respectively,P=0.000.CONCLUSIONS: The pathological stage,differentiation grade and myoinvasion depth are independent prognostic factors of endometrial adenosquamous carcinoma.PI is easy to calculate and may provide valuable information to physicians in individual treatment planning and in the stratification of patients for further clinical trails.