术前诊断为子宫内膜不典型增生的子宫内膜癌患者的处理

Management of endometrioid carcinoma patients with preoperative diagnosis of endometrial hyperplasia

目的分析和总结术前诊断为子宫内膜不典型增生的子宫内膜癌患者的临床特点及治疗方法。方法 2005年1月至2010年12月北京协和医院妇产科行全子宫切除术后病理诊断为子宫内膜样癌的患者共计404例,其中44例术前子宫内膜活检病理提示子宫内膜不典型增生(AEH),回顾性分析这些患者的临床特点,采用SPSS 13.0统计学软件进行分析。结果 44例术前诊断为AEH的患者中,39例(89%)患者未行子宫内膜癌分期术,子宫切除术后病理均为高分化子宫内膜样癌(100%),14例(32%)年轻患者保留了双侧卵巢,9例(20%)患者给予辅助放疗。中位随诊时间52个月,无复发病例。和绝经后患者相比,绝经前患者术后深肌层浸润(1/22及4/22)及淋巴血管间隙浸润(0/22及3/22)更少,但无统计学差异。比较AEH组和术前诊断为子宫内膜样癌的患者(EC组),AEH组高分化子宫内膜样癌的比例明显高于EC组(P=0.000);辅助化疗率和复发率明显低于EC组(P=0.003和0.019)。结论术前诊刮为AEH的子宫内膜癌患者预后好,年轻患者充分评估后可以考虑保留卵巢,绝经后患者AEH伴发子宫内膜样癌的风险增高,且更容易合并深肌层浸润、淋巴血管间隙受累等高危因素。

Objective To investigate the clinical characteristics and treatments of endometrioid carcinoma patients with preoperative diagnosis of endometrial hyperplasia. Methods From 2005 to 2010,404 patients were diagnosed with endometrioid carcinoma after hysterectomy. Among these patients,44 of them were diagnosed atypical endometrial hyperplasia（ AEH） preoperatively. Retrospectively analysis the characteristics of these patients with SPSS13. 0. Results Among the 44 cases,all of them were grade G1 disease,and 39 of them received comprehensive staging surgery. 14（ 32%） young cases preserved bilateral ovaries. 9 cases（ 20%） were given adjuvant radiology. No recurrence was detected during the median follow up of 52 months. Compared to the premenstrual group,although no statistical difference was detected,more patients with risk factors of deep myometrium invasion（ 4/22 vs1/22） and lymph-vascular space invasion（ LVSI,3/22 vs 0/22） in the postmenstrual group. Compared to the patients who diagnosed with endometrioid cancer（ EC） preoperatively,there are more patients with grade G1（ P =0. 000）,fewer patients received adjuvant chemotherapy（ P = 0. 003） and fewer recurrence（ P = 0. 019） in AEH group. Conclusions The endomtrioid cancer patients who diagnosed with atypical hyperplasia preoperatively have better prognosis. Hysterectomy with bilateral ovaries preserved is acceptable in young patients. Post menopause patients have more risk factors of deep myometrium invasion and LVSI.