晚期子宫内膜癌预后相关因素分析

Analysis of prognostic factors of advanced endometrial carcinoma

目的 探讨晚期子宫内膜癌预后相关因素。方法 回顾性分析我院1986年1月～1999年9月间收治的41例晚期子宫内膜癌患者临床病理资料和随访结果。结果(1)41例患者,Ⅲ期30例,其中Ⅲa期15例(36.6％),Ⅲb期3例(7.3％),ⅢC期12例(29.3％),Ⅳ期11例(26.8％)(均为Ⅳb期);子宫内膜样腺癌30例(73.2％),腺鳞癌5例(12.2%),浆乳癌5例(12.2%),透明细胞癌1例(2.4%);单纯手术2例,单纯放疗3例,单纯孕激素治疗1例,综合治疗35例;死亡17例,5年生存率35.4％。(2)Ⅲ期患者中,Ⅲa期复发3例,死亡2例,5年生存率65.6％;Ⅲb期盆腹腔复发1例(死亡),Ⅲc期复发转移8例,均死亡,5年生存率14.5％。(3)Ⅳ期患者中,盆腹腔复发3例,肺转移5例,死亡6例,3年生存率 27.7％。(4)子宫外多处癌灶22例,其中复发转移16例,死亡14例,占全部死亡的82.4％。结论 子宫内膜癌Ⅲc期预后明显差于Ⅲa期,子宫浆膜受侵、子宫外多处癌灶、宫旁组织受侵犯、宫旁淋巴管或血管有癌栓及淋巴结癌转移仍是影响Ⅲ期子宫内膜癌预后的重要因素,Ⅳ期患者易盆腹腔复发和肺转移,预后更差,晚期子宫内膜癌应进行综合治疗。

Objective To study the prognostic factors of advanced endometrial carcinoma. Methods Analysis of the clinical of pathological features of 41 cases of advanced endometrial carcinoma. Results (1) There were 41 cases of endometrial carcinoma in which 15 IIIa (36.6%), 3 IIIb (7.3%). 12 Die (29.3%) and 11 cases of stage IV b (26.8%). Histo-logically 30 cases (73.2% ) were endornetrioid, 5 adenosquamous (12.2% ), 5 papillary serous adenocarcinoma (12.2% ), and 1 clear cell carcinoma (2.4%). 2 cases were treated by surgery alone, 3 cases radiotherapy only, 1 case progesterone only, and combined treatment for 35 cases. 17 cases died, with a five year survival rate as 35.4% . (2) In the stage II cases, 3 IIIa recurred, 2 died, with a 5 year survival rate as 65.6% ; 1 III b recurred and died; 8 IIIc recurred and all died with the 5 year survival rate as 14.5% . (3) In stage IV cases, 3 had pelvic recurrence, 5 lung metastasis, and 6 died with a 3 year survival rate as 27.7%. (4) There were 22 cases with multiple extrauterine metastasis, in which 16 recurred, 14 died which was 82.4% of all the dead cases. Conclusion The prognosis of stage III c endometrial carcinoma was worse than that of stage ID a. The involvement of uterine serosa, lymph node metastasis, multi - lesion out of uterine, and lymphovascular invasion (LVI) were the important prognostic factors of stage III endometrial carcinoma. The recurrence of pelvic and peritoneal cavity and peritoneal cavity and long distance metastasis were found much more in stage IV b, which made a poor prognosis. Combined treatment should be given in these late cases.