子宫内膜癌临床分期与手术病理分期的比较

Comparison of Clinical Staging with Surgicopathological Staging for Endometrical Carcinoma

【目的】探讨子宫内膜癌临床分期与手术病理分期的差异 ,阐述其手术病理分期的优点及可行性。【方法】回顾性分析 1997～ 2 0 0 3年收治经手术治疗的 92例子宫内膜癌患者 ,将术前临床分期与术后病理分期进行比较 ,分析其差异及原因。【结果】临床分期误差率 :Ⅰ期为 2 0 .3% ,Ⅱ期为 33.3%。临床分期Ⅰ期中盆腹腔转移率 9.5 % ,Ⅱ期为 33.3% ,Ⅲ、Ⅳ期均为 10 0 % ,总转移率 16 .3% (15 / 92 )。子宫肌层浸润深度≥ 1/ 2患者盆腹腔转移率较 <1/ 2者高 (P <0 .0 1)。组织学分级G1、G2 的患者盆腹腔转移率低于G3 及未分化者(P <0 .0 1)。【结论】手术病理分期真实反映了病变范围 ,较临床分期准确。子宫内膜癌盆腹腔转移与临床分期、子宫肌层浸润深度 ,组织学分级密切相关。手术病理分期能客观判断预后 ,并指导术后治疗。

ObjectiveTo compare the difference between clinical and surgicopathological staging of endometrical carcinoma (EC) and elucidate the advantages and feasibility of its surgicopathological staging. Ninety-two patients with EC surgically treated in our hospital from 1997 to 2003 were retrospectively reviewed. Their preoperative clinical staging and postoperative surgicopathological staging were compared , the results difference and reasons were analyzed.The rates of error in clinical staging were 20.3% for stage Ⅰ and 33.3% for stage Ⅱ, respectively. The rates of pelvic and abdominal cavity metastasis were 9.5 % in clinical stage Ⅰ , 33.3% in clinical stage Ⅱ and 100% in stage Ⅲ/Ⅳ, respectively; the total rate of metastasis was 16.3%(15/92). Patients with cancer invasion ≥1/2 depth of myometrical wall displayed rate of pelvic and abdominal cavity metastasis higher than those with cancer invasion<1/2 depth of myometrial wall (P<0.01); whereas judging from histopathologial staging, patients with G 1,G 2 showed rate of pelvic and abdominal cavity metastasis lower than those with grade G3 and undifferentiation (P<0.01).[Conclusions]The surgicopathological staging really reflects the extent of cancer invasion and is more accurate than the clinical staging. The metastasis of pelvic and abdominal cavity in EC is closely correlated with its clinical staging, depth of myometrial invasion and histopathological staging. Surgicopathological staging can objectively ascertain the prognosis and guide postoperative therapy.