年轻早期子宫内膜癌患者保留卵巢的安全性及预后

Safety and prognosis of ovarian preservation in young women with early-stage endometrial cancer

目的探讨年轻的I期子宫内膜癌患者保留卵巢的安全性及预后。方法回顾性分析北京协和医院2005年1月至2011年12月间接受手术治疗的年龄≤45岁的I期子宫内膜癌患者的临床病理资料。根据术中是否保留卵巢分为保留卵巢组和切除卵巢组,比较分析两组的临床病理特征及预后。结果研究共纳入患者72例,其中保留卵巢组25例(34.7%),切除卵巢组47例(65.3%)。保留卵巢组患者与切除卵巢组患者相比更年轻(P=0.007),并且接受淋巴结切除的比例明显低于保留卵巢组患者(P<0.001)。两组患者在分期、肿瘤分级、肌层浸润深度以及术后辅助治疗方面均无统计学差异(P>0.05)。72例患者的中位随诊时间为89个月(7~131月),共有5例患者复发,没有患者死亡。Kaplan-Meier生存曲线及log rank检验显示两组的无复发生存时间无差异(P=0.194)。COX风险回归分析发现保留卵巢对无复发生存期无影响(HR=3.08,95%CI 0.54~18.44)。结论年轻的早期子宫内膜癌患者保留卵巢是安全的,对患者的无复发生存时间无显著影响。

Objective The aim of this study is to evaluate the safety and prognosis of ovarian preservation in young women with early-stage endometrial cancer. Methods Women≤45 years of age with stageⅠendometrial cancer recorded from Jan 2005 to Dec 2011 in Peking Union Medical College Hospital were examined. They were further divided into two groups： ovarian preservation group and oophorectomy group. Clinical and pathological recording of these patients were compared. Results A total of 72 women,including 25 patients（ 34. 7%） who had ovarian preservation,were identified. The ovarian preservation group was younger（ P = 0. 007） and had a lower prevalence of lymphadenectomy（ P〈0. 001）. While there were no significant difference in stage,tumor grade,the invasion depth of myometrium and adjuvant treatment between two groups（ all P〉0. 05）. Of seventy-two cases,five patients relapsed and all survived after a median follow-up time of 89 months（ rang： 7-131 months）. The Kaplan-Meier curve and the log rank test showed no difference in recurrence-free survival（ P = 0. 194）. In Cox model analysis,ovarian preservation had no effect on recurrence-free survival（ HR = 3. 08,95% CI 0. 54-18. 44）.Conclusions Ovarian preservation in young women with early-stage endometrial cancer is safe and has no negative effect on recurrence-free survival or overall survival.