子宫内膜腺鳞癌78例临床分析

Clinical Analysis of 78 Cases of Endometrial Adenosquamous Carcinomas

[目的]了解影响子宫内膜腺鳞癌预后的相关因素。[方法]中山大学肿瘤医院在1980年1月到1999年12月共收治子宫内膜腺鳞癌104例 ,其中78例采用手术或以手术为主的综合治疗 ,本文对其临床病理资料进行了回顾性分析。[结果]按FIGO1988年分期Ⅰ期22例、Ⅱ期17例、Ⅲ期30例、Ⅳ期9例 ,中位随访时间43.7个月(1～216个月) ,总的5年生存率61.1 % ,Ⅰ、Ⅱ、Ⅲ、Ⅳ期的5年生存率分别为93.1%、87.2%、35.8 %、0,病理分级G1、G2 、G35年生存率100%、73.0%、34.1% (P=0.0003) ,病灶侵及子宫内膜、浅肌层、深肌层者的5年生存率分别为100 %、100 %、41.8% (P=0.0000)。COX模型逐步回归结果表明手术病理分期、肿瘤分化程度、浸润深度是预后的危险因素。[结论]子宫内膜腺鳞癌总的预后较典型内膜腺癌差 ;但其早期患者5年生存率并不低 ,可见早期诊断的重要性 ;手术病理分期、肿瘤的分化程度及浸润深度是预后的主要影响因素 ;动脉化疗加全身化疗有利于改善晚期患者的预后 。

To clarify the prognostic factors of endometrial adenosquamous carcinoma.A total of 104 cases with endometrial adenosquamous carcinoma was treated in our hospital from Jan.1980 to Nov.1999. Among them,78 cases were treated by surgery alone or surgery based comprehensive treatment.Data of clinicopathology were analyzed retrospectively.The number of patients with pathological stageⅠ,Ⅱ,Ⅲ,Ⅳ was 22,17,30,9 respectively.Median follow up period was 43.7 months (range from 1 to 216 months).Overall 5 years survival rate was 61.1%,while the 5-year survival rate of stageⅠ,Ⅱ,Ⅲ,Ⅳ was 93.1%,87.2%,35.8%,0 respectively.The 5-year survival rate in patients with G1?G2 ?G3 was 100%,73.0%,34.1% respectively(P=0.0003).The 5_year survival rate in patients with the myoinvasion depth 0,<1/2,>1/2 was 100%,100%,41.8%respectively(P=0.0000). Multivariate analysis revealed that surgicopathological stage,grade and myoinvasion depth were independent factors for overall survival rate. [Conclusion]: The prognosis of endometrial adenosquamous carcinoma is worse than that of adenocarcinoma. However, the 5_year survival rate of patients with early stage is not low, therefore, early diagnosis is very important.The pathological stage, differential grade and myoinvasion depth are independent factors for overall survival rate. Adjuvant chemotherapy via vein and pelvic artery could improve the survival,but its actual significance deserves further investigation.