绝经前、后子宫内膜癌临床病理特征对比分析

Clinicopathological features in premenopausal and postmenopausal patients with endometrial cancer

目的分析绝经前、后子宫内膜癌患者的发病高危因素、病理特征及预后。方法回顾性分析2010年1月至2016年12月北京大学人民医院收治的未绝经子宫内膜癌患者182例，与同期绝经后子宫内膜癌328例进行比较。结果①发病高危因素：绝经前组平均发病年龄小，初潮早，孕次、产次少；未孕、未产比例高，合并高血压比例低，但在合并肥胖、糖尿病及肿瘤家族史等方面，两组差异无统计学意义（P〉0．05）；②病理特征：绝经前组G1比例高、特殊病理类型少、子宫深肌层浸润少、P53阳性率低、Ki一67低，PR阳性率高；在FIGO分期、宫颈间质受累、淋巴结转移、淋巴脉管浸润、附件转移、腹水肿瘤细胞阳性、ER阳性等方面，差异无统计学意义（P〉0．05）；③预后：绝经前患者3年总生存率99％，无瘤生存率98．1％，显著高于绝经后组（92．9％，P=0．021；88．5％，P=0．004）。结论绝经前子宫内膜癌初潮早，孕、产次少，肿瘤分化好、子宫深肌层浸润少，特殊病理类型少并且P53阳性率低、PR阳性率高，预后较好。因此，应该针对绝经前、后子宫内膜癌的临床病理特点，制定诊疗方案，避免过度治疗与治疗不足。

Objective To analyze the risk factors, pathological features and prognosis of premenopausal endometrial cancer. Methods A total of 510 patients with endometrial cancer admitted during January 2010 and December 2016 were divided into premenopausal group （n=182） and postmenopausal group （n=328）. The risk factors, pathological features and prognosis were recorded and compared. Results ① proRisk factors： In the premenopausal group, the ages of diagnosis and menarche were younger, gravidity and parity were less, theportions of nulligravity and nulliparity were higher,, the proportion of patients with hypertension was lower. ② Pathological features： The premenopausal group had better differentiation, less special pathological type, less deep myometrial invasion, lower positive rate of P53, lower Ki-67, and higher positive rate of PR. ③ Prognosis： The 3- years overall survival （99.0% vs 92.9%, P=0.021） and disease free survival （98.1% vs 88.5%, P=0.004） in the premenopausal group were higher than those in the postmenopausal group. Conclusions The premenopausal group has a better prognosis owing to better differentiation, less special pathological type, less deep myometrial invasion, lower positive rate of P53, and higher positive rate of PR. Therefore, the treatment strategy should be tailored according to the characteristics of premenopausal endometrial cancer and avoid excessive treatment.