子宫内膜透明细胞癌24例临床分析

Clinical Analysis of 24 Cases with Uterine Clear Cell Carcinoma

目的:探讨子宫内膜透明细胞癌的临床特点及治疗方法。方法:回顾性分析24例子宫内膜透明细胞癌患者的临床表现、病理特征和治疗结果。结果:24例患者确诊为子宫内膜透明细胞癌时的平均年龄57.5岁。术前诊刮的准确率为62.5%。单独化疗12例,放疗2例,孕激素治疗1例,放疗联合化疗7例,放疗或化疗联合孕激素治疗各1例。行彻底肿瘤切除术患者1例术后死亡,余患者平均随访时间29.3个月无复发。手术未切净的5例患者中1例失访,余复发。结论:子宫内膜透明细胞癌晚期病例多,发病年龄与子宫内膜样癌相仿,诊刮准确率低。治疗宜采取全面的手术病理分期、以铂类为主的化疗及盆腔、阴道放疗,预后恶劣。

Objective：To investigate the clinical featuras, management , and prognosis of uterine clear-cell carcinoma.Metlhods： Twenty-four cases of uterine clear-cell carcinoma patients admitted in PUMC hospital between Jan 1984 and Aug 2004 were analyzed retrospectively. Results：The median age at the time of diagnosis was 57.5 years （range 38-75 years）,the accurate rate of biopsy was 62.5%. Twenty-two patients underwent complete surgicalpathological staging.Their RGO （1988） surgical-pathological stage was as follows：15 Ⅰ ,2 Ⅱ,2 Ⅲ ,and 3 Ⅳ .One patient was clinically diagnosed as stage Ⅳ. Adjuvant therapies included the follows： 12 with chemotherapy alone,2 with RT （ radiation therapy） ,1 with hormone therapy alone,7 with combination of RT and chemotherapy,1 with combination of chemotherapy and hormone therapy, and I with combination of RT and hormones therapy, Paclitaxel alone or in combining other medicines were chosen as chemotherapy regimen for six courses. Patients with radical surgery were followed up for 29.3 months without relapse except one patient died 11 months after optimal operation. 5 patients with sub-optimal surgery relapsed and one lost follow-up, Conclusions： Clear-cell carcinoma comprises a small percentage of endometrial cancers, has been shown to be associated with high relapse rate and poor survival. Patients with uterine clear-cell carcinoma should be treated with complete staging surgery,combinations of local regional RT and chemotherapy play an important role to reduce the risk of local and systemic recurrence.