年轻妇女子宫内膜癌626例临床分析

Clinical Analysis of 626 Young Patients with Endometrial Carcinoma

目的:探讨年轻妇女子宫内膜癌的临床特征与病理特点。方法:回顾分析广东省34家医院2000～2010年住院经病理检查确诊的年轻妇女子宫内膜癌(年龄≤40岁)626例的临床资料。结果:子宫内膜癌中年轻患者构成比无逐年增多的趋势,其发病平均年龄无下降趋势;93.6%为子宫内膜样腺癌,92.0%为G1和G2;87.2%无和≤1/2肌层浸润;术后手术-病理分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为71.6%,10.6%,16.1%,1.7%。术前临床误诊率为19.0%;临床分期Ⅰ、Ⅱ、Ⅲ期与手术-病理分期比较的误差率分别为18.6%,53.5%,18.9%。单因素分析显示组织学分级G3(P<0.01)、深肌层浸润(P<0.01)、腹水细胞学阳性(P<0.01)是卵巢转移的高危因素,而在多因素分析时均无统计学意义。单因素分析显示组织学分级G3(P<0.01)、深肌层浸润(P<0.01)、宫颈受累(P<0.01)、腹水细胞学阳性(P<0.05)、脉管浸润(P<0.01)是淋巴结转移的高危因素,多因素分析时,只有宫颈受累(P<0.05)和组织学分级G3(P<0.05)具有统计学意义。结论:年轻妇女子宫内膜癌患者占有一定比例,但未见有年轻化趋势。病理以子宫内膜样腺癌、G1/G2为主;手术病理分期多数为Ⅰ期。术前临床误诊率高。宫颈受累和组织学分级G3为淋巴结转移的独立高危因素。

Objectives： To assess the characteristics of young women with endometrial carcinoma. Meth- ods： We retrospectively analyzed young women （ ≤40 years） diagnosed with endometrial cancer from 34 hospitals between 2000 and 2010 in Guangdong province. Results： The percentage of young patients was not tended to be ascending from 2000 to 2010, and theirs mean age at diagnosis was not tended to be de- scending. Endometrioid adenocarcinoma was found in 93.6% young patients. 92.0% young patients were G1 and G2 , 87.2% young patients were.≤1/2 myometrial invasion, The overall distributions by stages were stage Ⅰ 71.6%, Ⅱ 10.6%, Ⅲ 16.1%, and IV 1.7%. The percentage of preoperative misdiagnose was 19.0%, and the error rates of pre-operative clinical stage Ⅰ , Ⅱ, Ⅲ were 18.6%, 53.5%, 18.9%, re- spectively. Ovarian metastasis was correlated with histological grades G3 （ P 〈 0.01 ）, deep myometrial in- vasion （ P 〈0.01 ）, positive abdominal dropsy cytology （ P 〈 0.01 ）. But multivariate analysis did not show statistic significance. Lymph node metastasis was correlated with histological grades G3 （ P 〈 0.01 ）, deep myometrial invasion （ P 〈 0.01 ）, cervical invasion （ P 〈 0.01 ）, positive abdominal dropsy cytology （ P 〈 0.05）. lymphatic vascular invasion （ P 〈 0.01 ）. But the multivariate analysis showed that only histologicalgrades G3 （ P 〈 0.05） and cervical invasion （ P 〈 0.05） were statistically significant. Conclusions： A certain proportion of endometrial cancer are young patients, but there isn＇ t a trend of more young patients. The pathological characteristics in young patients with endometrial cancer tend to be diagnosed at an early stage, G1/G2 endometrioid adenocarcinoma. Preoperative misdiagnosis is really common in clinic. Cervical inva- sion and G3 are independent risk factors for lymph node metastasis.