子宫内膜癌治疗的临床探讨

Treatment of Endometrial Cancer

目的探讨Ⅰ期子宫内膜癌(EC))的手术方式以及术后激素治疗和放疗的必要性。方法对67例EC患者进行回顾性分析,其中Ⅰ期37例、Ⅱ期8例、Ⅲ期14例、Ⅳ期8例;根据手术方式不同,将Ⅰ期患者分为3组,行次广泛/广泛子宫及附件切除术和腹膜后淋巴结清扫术或腹膜后淋巴结取样术为A组(24例),行次广泛子宫及附件切除术为B组(5例),行全子宫及附件切除术和腹膜后淋巴结清扫术为C组(8例)。分析患者的生存情况,比较激素治疗、放疗对Ⅰ期患者预后的影响。结果寿命表法计算总体5年生存率为78.99%,Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的5年生存率分别为88.65%、86.67%、77.92%和28.57%;细胞分级G3、深肌层侵犯、非子宫内膜样癌和淋巴结转移是影响预后的高危因素(P<0.05),Ⅰ期有高危因素组的5年生存率(80%)显著低于无高危因素组(100%),P<0.05;A、B和C组之间无明显生存差异(P>0.05),但A组手术方式有利于正确分期;Ⅰ期患者术后激素治疗的5年生存率(100%)显著高于无辅助性治疗对照组(86.67%),放疗(88.89%)与无辅助性治疗对照组之间无明显差异。结论A组手术方式可明确分期,指导治疗,但扩大的手术范围和腹膜后淋巴结清扫或取样不作为Ⅰ期患者的治疗手段,术后仍应给予恰当的辅助性治疗;激素治疗有利于改善Ⅰ期患者的预后,放疗的必要性则有待探讨。

Objective To explore the operative procedure and necessity of hormone therapy and radiotherapy on endometrial cancer （EC）. Methods In a retrospective trial, 67 EC patients were enrolled in this study, including 37 cases of stage Ⅰ , 8 cases of stage Ⅱ , 14 cases of stage Ⅲ and 8 cases of stage Ⅳ. The patients in stage Ⅰ were divided into three groups： group A （n= 24） receiving subradical/radical hysterectomy, salpingo-oophorectomy plus retroperitoneal lymphadenectomy or retroperitoneal lymph nodes sampling, group B （n= 5） subject to subradical/radical hysterectomy and salpingo-oophorectomy, and group C （n=8） undergoing hysterectomy and salpingo-oophorectomy plus retroperitoneal lymphadenectomy. The survival was analyzed, and the effects of hormone therapy and radiotherapy on the prognosis of stage Ⅰ were compared. Results The total 5-year survival rate was 78. 99%. The 5-year survival rate in the patients with stage v , Ⅱ,Ⅲ and Ⅳ was 88.65%, 86.67%, 77.92 % and 28.57% respectively. Grade 3, invasion to deep muscular layer, non-endometrioid carcinoma and lymph node metastasis were the high risks influencing the prognosis. The 5-year survival rate （80%） of stage Ⅰ with high risks was lower than that （100%） of stage I without high risks （P（0.05）. There was no significant difference in 5-year survival rate among groups A, B and C. We observed no differences compared group A with group B or group C. The surgical procedures used in group A was beneficial to the staging. The 5-year survival rate in stage Ⅰ patients subject to hormone therapy was significantly higher than in the controls not receiving the adjuvant therapies. There were no dramatically difference between the radiotherapy group and the control group. Conclusion Subradical/radical hysterectomy, salpingo-oophorectomy plus retroperitoneal lymphadenectomy or retroperitoneal lymph nodes sampling had more advantages in distinguishing the stage. But the enlargement of operation field and retroperitoneal lymphadenectomy or retroperitoneal lymph nodes sampling were not the necessary therapeutic methods for stage Ⅰ , and the adjuvant therapies should be given after operation. The hormone therapy did significantly improve the outcome and had less side effects than other adjuvant therapies. The necessity of the radiotherapy was still on studying.