子宫内膜癌雌激素水平与预后因素关系探讨

STUDY ON ESTROGEN LEVELS AND PROGNOSIS IN PATIENTS WITH ENDOMETRIAL CANCER

分析了我院手术并经病理证实的绝经后子宫内膜癌６９例的临床资料，以术前血浆雌二醇大于１５０ｐｍｏｌ／Ｌ与否分二组，Ⅰ组——高雌激素组３９例，（５６．５２％），平均值５３４±４３５．１ｐｍｏｌ／Ｌ，Ⅱ组——低雌激素组３０例，（４３．４８％），平均值７３．９７±５３．４９ｐｍｏｌ／Ｌ。比较二组临床表现，伴发疾病，肿瘤生物学行为发现：Ⅰ组绝经后阴道流血，伴发疾病比Ⅱ组明显高（Ｐ＜０．０５）；肌层浸润，宫颈转移率显著低于Ⅱ组（Ｐ＜０．０５）；细胞分化好，临床期别早，癌周内膜不同程度增生过长显著高于１组（ｐ＜０．０５）；萎缩型内膜则Ⅱ组明显高（Ｐ＜０．０５）；５年生存率Ⅱ组比Ⅰ组低，但无显著差异（Ｐ＞０．０５）。提示：子宫内膜癌一种疾病有二种发病类型，一种雌激素过多型，另一种无雌激素过多。不同类型肿瘤生物学行为及形态学特征和预后均不同。高雌激素型内膜癌预后良好。临床对内膜癌患者测雌激素水平将病人分型有助于评价预后。

e analysed sixty- nine postmenopausal patients with endometrial cancer. Thesepatients were divided into two groups according to the serum estrogen level.The firstgroup included patients with hyperestrogenism(56.52%)and the second group waswith hypoestrogenism(43.48%). The differences in clinical signs and associated disea- ses and biological behavior of tumor between twe groups were evaluated. We foundthat the frequencies of postmenopausal vaginal bleeding,obesity, diatetes mellitus,welldifferentiated tumor, early clinical stage and hyperplasia of endometrium in thefirst group were higher than that in the second group(P<0. 05),whereas the frequen-cies of invasion of myometrium. and pelvic lymph nodes and atrophy of endometrim in the second group were higher than that in the first group(P<0. 05). The five-yearsurvival rate was higher in the first group. Ttese results suggest that there are twodifferent pathogenetic types of endometrial carcinoma with different biological beha-vior, morphologic features and prognosis.Hyperestrogenism may be a favorable progno-stic factor for endometrial carcinoma, Measurement of serum estrogen level may helpassess prognosis in endometrial cancer.