子宫内膜腺癌卵巢转移的危险因素及卵巢保留的可行性

Risk factors of ovarian metastasis and feasibility of ovarian preservation in endometrial adenocarcinoma

目的分析子宫内膜腺癌卵巢转移的危险因素,探讨子宫内膜腺癌患者卵巢保留的可行性。方法回顾性分析2012年1月-2016年12月辽宁省肿瘤医院妇科收治的子宫内膜腺癌患者508例,均行手术治疗并经病理确诊为子宫内膜腺癌,收集患者临床资料,分析影响卵巢转移的危险因素。结果 508例患者有34例(6.69%)患者存在卵巢转移。子宫内膜腺癌卵巢转移与患者年龄、是否绝经、肿瘤部位均无相关性(P>0.05);而与临床分期、肿瘤分化程度、肌层浸润、肿瘤直径(≥2 cm)、宫颈受累、脉管浸润、盆腹腔淋巴结转移、腹水癌细胞阳性、CA125升高具有相关性(P<0.05)。Logistic分析发现,临床分期(Ⅲ~Ⅳ期)、脉管浸润、盆腹腔淋巴结转移、腹水癌细胞阳性、CA125升高为独立的危险因素(P<0.05)。结论早期子宫内膜腺癌患者卵巢转移几率较小,存在保留卵巢的可能性,临床分期(Ⅲ~Ⅳ期)、脉管浸润、盆腹腔淋巴结转移、腹水癌细胞阳性、CA125升高是独立危险因素。

Objective To analyze the clinical characteristics and risk factors of ovarian metastasis in endometrial cancer patients,explore the feasibility of ovarian preservation. Methods A retrospective analysis of 508 patients surgically staged for endometrial adenocarcinoma from January 2012 to December 2016 was performed. Collect the clinical data, and analyze the risk factors of ovarian metastasis. Results Among 508 patients,ovarian metastasis occurred in 34 patients,the incidence rate was 6. 69%(34/508). Age, menopause or not, and tumor location were not correlated with ovarian metastasis(P>0. 05). The degree of tumor differentiation,depth of myometrial invasion, tumor size( ≥2 cm), cervical invasion,lymphovascular space invasion( LVSI), pelvic and para-aortic lymph node metastasis, positive ascites cells, and positive CA125 were correlated with ovarian metastasis(P <0. 05). Logistic analysis showed that lymphovascular space invasion(LVSI), pelvic and para-aortic lymph node metastasis, positive ascites cells,and positive CA125 were independent risk factors of ovarian metastasis( P <0. 05). Conclusion The incidence rate of ovarian metastasis in patients with early endometrial adenocarcinoma is low,ovarian preservation is feasible; lymphovascular space invasion( LVSI), pelvic and para-aortic lymph node metastasis, positive ascites cells,and positive CA125 are independent risk factors of ovarian metastasis.