子宫浆液性乳头状癌11例临床分析

Uterine papillary serous carcinoma:a clinical study of 11 cases

目的:分析子宫浆液性乳头状癌(uterine papillary serous carcinoma,UPSC)的临床病理特征、治疗和预后。方法:对11例UPSC和185例子宫内膜样癌(uterine endometrioidcarcinoma,UEC)进行对比分析。结果:UPSC的发生率为4.7%,发病平均年龄UPSC组(60.0岁)明显高于UEC组(52.5岁),t=2.52,P<0.05。两组的主要临床表现均为绝经后阴道流血,UPSC组无合并高血压及糖尿病病例,而UEC组43例(23.24%)合并高血压,31例(16.76%)合并糖尿病,两组比较差异有统计学意义,χ2=4.208,P=0.04。UPSC组和UEC组Ⅲ、Ⅳ期患者分别为5例(45.45%)和45例(24.73%),χ2=8.031,P=0.04;G3级患者分别为6例(54.55%)和51例(27.57%),χ2=6.091,P=0.04;肌层浸润深度>1/2者分别为7例(67.64%)和62例(33.51%),χ2=4.493,P=0.04;p53阳性者分别为9例(81.8%)和34例(18.4%),ER阳性者分别为1例(9.1%)和79例(42.7%),PR阳性者分别为1例(9.1%)和65例(35.1%),χ2=5.841,P=0.02。与UEC组一致,UPSC组亦以手术为主,11例均接受手术治疗,5例术后辅以化疗、放疗,但死亡率(45.45%)较UEC组(15.14%)明显高,χ2=8.266,P=0.01。结论:UPSC少见,发病年龄偏大,病期晚,分化差,肌层浸润深,临床预后明显不良。手术为其治疗的首选方法,手术范围类卵巢癌,术后辅助放疗不能降低复发率,化疗效果有待进一步研究。

OBJECTIVE： To study the clinicopathological features, treatment and prognosis of uterine papillary serous carcinoma （UPSC）. METHODS： Eleven cases of UPSC and 185 cases of uterine endometrioid carcinoma （UEC） were contrastively analyzed. RESULTS： Eleven cases of UPSC accounted for 4.7 % of carcinoma of uterine endometrium. Their average age was 60.0 years in UPSC and 52.5 years in UEC （t=2.52, P〈0.05）. The most common symptom in the two groups was irregular postmenopausal vaginal bleeding. None in the UPSC group suffered from hypertension or diabetes, compared with 43 （23.24 % ） cases of hypertension and 31 （ 16.76 % ） cases of diabetes in the UEC group （Х^2 =4. 208, P=0. 04）. Patients of stageⅢ-Ⅳ were 5 （45.45%） in UPSC and 45 （24.73%） in UEC （？（2 =8. 031, P=0. 04）. Grade 3 cases were 6（54. 55%） in UPSC and 51（27.57%） in UEC （Х^2 =6. 091, P=0. 04）. Deep myometial invasion occurred in 67.64% of UPSC and 33.51% of UEC cases （Х^2 =4. 493, P=0.04）. There were significant differences between UPSC and UEC in the expression of ER, PR and p53 protein （Х^2 =5. 841, P=0.02）. Surgery was the major way to deal with UPSC patients. Postoperative chemotherapy and radiotherapy were used often too. However, the death rate of UPSC （45.45%） was higher than that of UEC （15.14%）,Х^2= 8. 266, P= 0. 01. CONCLUSIONS： UPSC is a kind of uncommon cancer. UPSC patients are usually older than UEC ones. Many UPSC patients are advanced, grade 3 and p53 protein positive. Deep myometial invasion cases are more commonly seen in UPSC. Surgery is the most effective treatment. Operation way in UPSC is similar to ovarian carcinoma. Postoperative radiotherapy cannot reduce the rate of local recurrence, however, chemotherapy seems to be useful.