子宫恶性肿瘤骨转移八例临床分析

Clinical analysis of eight cases of bone metastasis of uterine carcinomas

目的 探讨子宫恶性肿瘤骨转移的临床特征、危险因素和预后.方法 回顾性分析2001年3月至2005年6月北京大学人民医院收治的316例子宫恶性肿瘤中发生骨转移的8例患者的临床病理资料.其中,宫颈癌5例,子宫内膜癌3例.结果 （1）骨转移时间：子宫恶性肿瘤诊断后发生骨转移的时间一般在2年内.低分化患者中,平均发生骨转移时间为5.3个月;中～高分化患者,平均发生骨转移时间为21.0个月.（2）骨转移部位：骨盆转移6例,腰骶椎转移4例,肋骨转移1例;单一部位骨转移6例,两处及以上部位骨转移2例.（3）骨转移危险因素：子宫恶性肿瘤骨转移的发生率为2.5%（8/316）,其中特殊病理类型37例中3例（包括宫颈腺癌、子宫内膜奖液性乳头状腺癌、伴有透明细胞癌的子宫内膜样腺癌各1例）发生骨转移,占8.1%;低分化67例患者中3例发生骨转移,占4.5%.特殊病理类型、低分化为发生骨转移的危险因素.（4）治疗及预后：8例发生骨转移的患者中,3例未接受任何治疗或只接受了对症支持治疗,均在6个月内死亡;其他5例患者接受了手术治疗或放、化疗,目前存活4例（生存时间分别为5、5、8、12个月）.结论 子宫恶性肿瘤骨转移一般在诊断后2年内发生,以骨盆和椎骨为主要转移部位,特殊病理类型、低分化为发生骨转移的危险因素.子宫恶性肿瘤发生骨转移者预后不良,积极治疗骨转移可以在一定程度上延长患者的生存时间.

Objective To investigate the clinical feature, risk factors and prognosis of bone metastasis from uterine carcinomas. Methods Eight cases of bone metastasis of uterine carcinomas in our hospital from Mar 2001 to Jun 2005 were studied retrospectively. These eight women, aged 35 to 74, suffered from cervical cancer （5/8） and endometrial carcinoma （3/8） respectively. Results （ 1 ） The interval between diagnosis of primary carcinoma and detection of bone metastases was within 2 years. The average interval was 5.3 months in patients with poorly differentiated tumor, and 21 months in the other patients. （2） Specific pathology type and poorly differentiated carcinomas may be risk factors of bone metastasis. （3） Three patients did not receive therapy of bone metastasis, and died within 6 months. In the other five patients, four are still alive. Conclusions The interval between diagnosis of uterine carcinoma and detection of bone metastases is within two years. The most common sites are pelvic bone and vertebrae. Specific pathology type and poorly differentiated carcinomas may be risk factors of bone metastasis. The prognosis of bone metastasis of uterine carcinomas is poor. Treatment of bone metastasis is primarily palliative and may prolong survival.