雌激素依赖型与非雌激素依赖型子宫内膜癌临床病理特征的研究

A Study on the Clinicopathological Characteristics of Estrogen－Dependent and Estrogen－Independent Endometrial Carcinoma

目的：研究雌激素依赖型（Ⅰ型）和非雌激素依赖型（Ⅱ型）子宫内膜癌的临床病理特征。方法：根据患者是否存在雌激素的高危因素，将162例子宫内膜癌患者分为Ⅰ型及Ⅱ型，并对两型的临床病理特征进行回顾性分析。结果：Ⅰ型患者占72．8％，Ⅱ型占27．2％，Ⅱ型以绝经后患者多见。具有较高恶性程度的非内膜样腺癌（包括透明细胞癌、浆液性腺癌）在Ⅱ型中占13．6％，在Ⅰ型中仅占4．2％（P＜ 0．05）。Ⅱ型患者的分级以中、低分化多见；Ⅱ型的深肌层浸润、淋巴转移率和腹腔细胞学阳性率明显高于Ⅰ型（P分别＜ 0．01），手术Ⅲ、Ⅳ期的比率较Ⅰ型亦有显著增加（P＜ 0．05）。结论：非雌激素依赖型（Ⅱ型）子宫内膜癌分级高，肌层浸润深，分期晚，容易出现转移，预后不好。

Objective To investigate the clinicopathological characteristics of estrogen－dependent typeⅠ and estrogen－independent typeⅡ endometrial carcinoma． Methods The clinicopathological features of 162 cases of endometrial carcinoma were analysed retrospectively according to whether or not the genesis of tumor was dependent on estrogen． Results The incidence of typeⅠand type Ⅱ were 72．8％ and 27．2％ respectively The rate of postmenopause patients in type Ⅱ was significantly higher than that in typeⅠ 79．5％ vs 52．5％ P＜ 0．05． There were more virulent types of nonendometrioid carcinoma serous adenocarcinoma clear cell adenocarcinoma in typeⅡ as compared with typeⅠ13．6％ vs 4．2％ P＜ 0．05． The rate of high grade grade 2 3 deep myometrial invasion lymph node metastasis and peritoneal cytology positive in typeⅡ were higher than those in type I respectively 68．2％ 50．0％ 19．0％ 27．5％ vs 46．6％ 23．7％ 5．2％ 11．8％ P＜ 0．05． The patients with surgical stage Ⅲ or Ⅳ in typeⅡ were more than those in type I P＜ 0．05． Conclusion The estrogen－independent endometrial carcinoma type Ⅱ is a more malignant type with high grade deep myometrial invasion late stage and frequent lymph node metastasis． The prognosis of type Ⅱ