术后化疗对有高危因素的早期子宫内膜癌患者预后的影响

Effects of postoperative chemotherapy on the prognosis of patients with high-risk early stage endometrial cancer

目的探讨术后化疗对有高危因素的早期（Ⅰ、Ⅱ期）子宫内膜癌患者预后的影响。方法选择1994年1月-2007年6月间，北京大学第一医院妇产科收治的66例有高危因素的早期子宫内膜癌且术后均辅以化疗的患者（化疗组），40例相同期别及相同高危因素但术后未予化疗者作为对照组，Kaplan-Meier法计算两组患者的5年累积生存率，并进行比较；对有高危因素的早期子宫内膜癌患者的预后影响因素进行单因素及多因素分析。结果化疗组患者的5年累积生存率为94％，对照组为81％，化疗组明显高于对照组（P〈0．05）。单因素分析显示，化疗组中I〉4个疗程患者的5年累积生存率为100％，〈4个疗程患者的5年累积生存率为86％，两者比较，差异有统计学意义（P〈0．05）；而不同年龄、手术病理分期、病理类型、病理分化程度及术后有无放疗、术后化疗后是否联合放疗、有无孕激素治疗患者间比较，差异均无统计学意义（P〉0．05）。多因素分析显示，术后化疗是影响有高危因素的早期子宫内膜癌患者预后的独立因素（P〈0．05）。结论术后化疗可改善有高危因素的早期子宫内膜癌患者的预后，且疗程数应≥4个，但因例数较少，需通过前瞻性随机对照研究的进一步证实。

Objective To investigate the effects of adjuvant chemotherapy for patients with highrisk stage Ⅰ and Ⅱ （early stage）endometrial cancer. Methods From Jan. 1994 to Jun. 2007,106 cases with early stage high-risk endometrial cancer were treated in Peking University First Hospital and were divided into two groups based with postoperative adjuvant chemotherapy （ACT group,66 cases） and without adjuvant chemotherapy（ control group,40 cases ）. The 5-year survival rates was calculated by Kaplan-Meier method. Prognosis factors were further determined by univariate analysis and Cox proportional hazards models. Results The 5-year survival rate in the ACT group was significantly higher than that in control group （94% and 81%, P 〈 0. 05 ）. On the univariate analysis, the 5-year survival rate of patients received four or more cycles combined chemotherapy was higher than that of cases less than four cycles chemotherapy （100% and 86%, P 〈 0. 05 ）. While, it were not significant difference in age, stage, histology, grade, radiotherapy alone, chemotherapy combined radiotherapy or progestin hormonal therapy（ P 〉 0. 05 ）. On the multivariate analysis, adjuvant chemotherapy was found to affect independent prognostic covariates on early stage cases（P 〈 0. 05）. Conclusion Postoperative adjuvant chemotherapy maybe improve the prognosis of patients with high-risk early stage endometrial cancer, which need to be further study by prospective randomized trials.