Ⅲ及Ⅳ期子宫内膜癌预后因素探讨

Prognostic Factors of Stage Ⅲ,ⅣEndometrial Carcinoma

目的 :探讨影响Ⅲ、Ⅳ期子宫内膜癌的预后因素。方法 :Ⅲ、Ⅳ期子宫内膜癌 78例 ,按治疗方式分 4组 :单纯放疗组 8例 ,单纯手术组 7例 ,手术联合化疗及放疗组 4 6例 ,放疗加化疗组 14例 ,另 3例为化疗加激素治疗。结果 :78例总的 3和 5年生存率分别为 6 1 5 % (4 8 78)和 2 9 0 % (18 6 2 ) ;子宫内膜腺癌为 6 5 2 % (4 5 6 9)和 34 0 % (18 5 3) ,子宫内膜腺鳞癌为 3 8和 0 ,两者 3年生存率 ,P >0 2 5 ,腺磷癌无 1例生存 5年。 3年生存率 :Ⅲ期 75 0 % (4 2 5 6 ) ,Ⅳ期 2 7 3% (6 2 2 ) ,P <0 0 0 1。 5年生存率 :Ⅲ期 4 0 5 % (17 4 2 ) ,Ⅳ期 5 0 % (1 2 0 ) ,P <0 0 1,差异均有极显著意义。腺癌组织学分级Ⅰ、Ⅱ、Ⅲ级 5年生存率差异有显著意义 ,P <0 0 5。治疗方式中以手术联合化疗及放疗组疗效佳 ,与单纯放疗及化疗加放疗组间差异无显著意义 ,3、5年生存率 ,P >0 0 5。结论 :影响晚期子宫内膜癌预后因素主要为FI GO期别、组织学类型。

Objective To explore the influence prognostic factors of stage Ⅲ,Ⅳ endometrial carcinoma.Methods Seventy-eight patients with Ⅲ,Ⅳ endometrial carcinoma were treated in the hospital.According to the therapeutic methods,the patients were divided into 4 groups.Eight cases were treated with radiotherapy alone,7 cases with surgery alone,46 cases with surgery combined with chemotherapy and radiotherapy,and 14 cases with chemotherapy and radiotherapy.In addition,3 cases were treated with chemotherapy and hormonotherapy.Results The 3-year and 5-year overall survival rates were 61.5%(48/78) and 29.0%(18/62) in 78 patients.The 3-year survival rates were 65.2%(45/69) of endometrial carcinoma and 3/8 of adenosquamous carcinoma,P>0.25.The 5-year survival rates were 34.0%(18/53) of endometrial carcinoma and 0 of adenosquamous carcinoma,The adenosquamous carcinoma had no 5-year survival.while the 3-year survival rate of stage Ⅲ was 75.0%(42/56) and of stage Ⅳ 27.3%(6/22),P<0.001.The 5-year survival rate of stage Ⅲ was 40.5%(17/42) and of stage Ⅳ 5.0%(1/20),P<0.01.The survival rates of 5-year were significantly different in pathologic histology Ⅰ,Ⅱ,Ⅲ of endometrial carcinoma P<0.05.The therapeutic method that surgery combined with chemotherapy and radiotherapy was well-effective.For the 3-year and 5-year survival rates of radiotherapy group alone,surgery group alone and surgery combined with chemotherapy and radiotherapy group,the differences were no statistically significant,P>0.05.Conclusons The FIGO stage,histologic type,histologic grade and selection of treatment modality are the main prognostic factors influencing stage Ⅲ,Ⅳ endometrial carcinoma.