子宫内膜癌卵巢转移危险因素的探讨

Study of the risk factors for ovarian metastasis in patients with endometrial carcinoma

目的 探讨子宫内膜癌卵巢转移的危险因素及手术中保留卵巢的可行性。方法 回顾性分析1997年1月至2006年12月在江西省妇幼保健院首治为手术治疗的638例子宫内膜癌患者的临床病理资料。结果 36例（5．6％，36／638）患者发生卵巢转移。单因素分析显示，子宫内膜癌卵巢转移的相关因素为病理类型、病理分级、子宫肌层浸润、腹水或腹腔冲洗液细胞学检查阳性、盆腔淋巴结转移、宫旁浸润、腹主动脉旁淋巴结转移、子宫浆膜浸润（P均〈0．05），而年龄、脉管浸润、宫颈浸润与卵巢转移无明显相关性（P均〉0．05）。多因素分析显示，子宫内膜癌卵巢转移的独立危险因素按危险强度排列为：盆腔淋巴结转移、腹水或腹腔冲洗液细胞学检查阳性、病理分级。结论 子宫内膜样腺癌、细胞高分化、无盆腔淋巴结转移、无腹主动脉旁淋巴结转移、无肌层浸润、腹水或腹腔冲洗液细胞学检查阴性、年轻的患者可考虑手术中保留卵巢。

Objective To investigate the risk factors for ovarian metastasis and the possibility of ovarian preservation in patients with endometrial carcinoma. Methods The clinicopathological features of endometrial carcinoma patients who were diagnosed and treated initially with a surgical staging procedure from Jan 1997 to Dec 2006 in our hospital were retrospectively reviewed. Results Of the 638 cases reviewed, 36 （5.6%, 36/638） had ovarian metastasis. Univariate analysis revealed that histological type and grade, myometrial invasion, positive peritoneal fluid cytology, pelvic lymph node metastasis, invasion of parauterine, para-aortic node metastasis and invasion of uterine serosa were significantly associated with ovarian metastasis （P 〈 0.05 ）; while age, lymph-vascular invasion and cervical invasion were not significantly associated with ovarian metastasis （ P 〉 0.05 ）. Factors predictive of ovarian metastasis by multivariate analysis were ranked as follows according to risk intensity： pelvic lymph node metastasis, positive peritoneal cytology, and histological grade. Conclusion In young patients with grade 1 endometrioid carcinoma, with no pelvic lymph node metastasis, no para-aortic lymph node metastasis, no myometrial invasion and with negative peritoneal fluid cytology, ovarian preservation could be considered.