子宫乳头状浆液性癌与子宫内膜乳头状腺癌生物学行为的临床分析

UterinePapilarySerousCarcinomaandPapilaryEndometrialCarcinoma:

目的：分析子宫乳头状浆液性癌及乳头状内膜腺癌的病理形态和生物学行为的特点。方法：对５６例含乳头状结构的子宫内膜癌患者行回顾性分析。其中子宫乳头状浆液性癌１５例，乳头状子宫内膜腺癌４１例。以普通子宫内膜腺癌１６０例作为对照。结果：各组诊断时，晚期病例的比例依次为２６．７％、１４．６％、５．６％（Ｐ＜０．０５）。宫外扩散率依次为５３．３％、２０．８％、１２．１％（Ｐ＜０．０１）。深肌层受侵犯的比例分别为７５．０％、４１．７％、３２．３％（Ｐ＜０．０１）。Ⅰ、Ⅱ期的５年生存率则各为４５．７％、６１．９％、９０．３％（Ｐ＜０．０１）。子宫乳头状浆液性癌以上腹部播散为主，未控率高达４６．２％。子宫内膜乳头状腺癌以盆内扩散为主，复发转移率达３１．０％。结论：乳头状结构的存在是子宫内膜癌的预后不良因素；子宫内膜乳头状腺癌的预后介于乳头状浆液性癌和普通子宫内膜腺癌之间。

Objective:Tocharacterizetheclinicalbiologicalbehaviorandthepathologicalmor-phologyofuterinepapilaryserouscarcinomaandpapilaryendometrialcarcinoma.Methods:Thisisaretrospectiveanalysisof56patientswithpapilaryendometrialcancertreatedatCancerHospital,ChineseAcademyofMedicalSciencesfromJanuary,1981toDecember,1993.Ofthe56cases,15wereuterinepapilaryserouscarcinomas(UPSC),41papilaryendometrialcarcinomas(PEC).Onehundredandsixtypatientswithendometrialadenocarcinoma(AC)weresubmitedascontrolgroup.Results:26.7%ofUPSC,14.6%ofPECand5.6%ofACpatientshadstageⅢorⅣbyclinicalex-amination(P<0.05),whereas53.3%ofUPSC,20.8%ofPECand12.1%ofACpatientshadex-trauterinediseaseatsurgery(P<0.01).Deepmyometrialinvasionoccurredin75.0%ofUPSC,41.7%ofPEC,and32.3%ofACpatients(P<0.01).Anincreasinggradientof5yearsurvivalrate(lifetablemethod)wasobservedfromUPSC(45.7%)toPEC(61.9%)toAC(90.3%)intheirearlystage(stageⅠ～Ⅱ)(P<0.01).UpperabdominalspreadwasacommonfindinginUPSCwhichhadahighrateofpersistentdisease(46.2%).ThepelviswasthepredominantinvolvingsiteinPECwithahighfrequencyofrecurrenceandmetastasis(31.0%).Conclusions:Thepresenceofpapilaryfeaturesinendometrialcarcinomaisanimportantprognosticindicator.TheprognosisofPECisbetterthanUPSC,butworsethanAC.