早期子宫内膜癌患者腹腔冲洗液细胞学阳性的危险因素和预后的意义

The risk factors and prognostic significance of abdominal irrigation solution cytology in patients with early endometrial cancer

目的探讨早期子宫内膜癌患者腹腔冲洗液细胞学阳性的危险因素和预后的意义。方法回顾性分析2013年5月至2016年12月山东省青岛市肿瘤医院收治的268例子宫内膜癌患者的病例资料,其中腹腔冲洗液细胞学阳性者纳入研究组,共28例;腹腔冲洗液细胞阴性者纳入对照组,共240例。分析其发病年龄、内科合并症、病理类型、组织学分级、肌层浸润深度、宫颈间质侵犯和淋巴血管间隙受累情况是否为腹腔冲洗液细胞学阳性的危险因素,并随访其预后,比较两组的预后情况及其影响因素。结果发病年龄、病理类型、肌层浸润深度和宫颈间质侵犯在两组之间差异具有统计学意义(P<0.05),内科合并症、组织学分级、淋巴血管间隙受累在两组之间差异无统计学意义(P>0.05)。研究组患者的5年总体生存率和无进展生存率分别为92.59%、81.48%,对照组5年总体生存率和无进展生存率分别为97.87%、93.61%。两组患者的总生存率(χ~2=8.983,P=0.012)和无进展生存率(χ~2=14.533,P<0.001)差异均具有统计学意义。腹腔冲洗液细胞学检查结果是否阳性不是患者总生存率和无进展生存率的影响因素,而发病年龄、病理类型、肌层浸润深度则为患者总生存率和无进展生存率的影响因素。结论腹腔冲洗液细胞学检查阳性虽然不是早期子宫内膜癌预后的影响因素,但是,由于腹腔冲洗液细胞学检查阳性患者的预后较阴性患者差,在临床上仍有必要进行腹腔冲洗液细胞学检查,并在阳性时予以重视和积极处理。

Objective To investigate the risk factors and prognostic significance of abdominal irrigation solution cytology in patients with early endometrial cancer. Methods A total of 268 cases of endometrial cancer were selected retrospectively in Shandong Province Qingdao Tumor Hospital. Patients with abdominal irrigation solution cytology positive were included in the study group,with a total of 28 cases,and abdominal irrigation solution cells negative were included in the control group,with a total of 240 cases. The age,medical comorbidities,pathological types,histological grade,depth of myometrial invasion,cervical interstitial invasion and lymphatic vascular space involvement were analyzed as risk factors of cytologic positive abdominal irrigation solution and their prognosis were compared. Prognosis and its influential factors were also followed up and compared. Results The age of onset,pathological type,depth of myometrial invasion and cervical interstitial invasion were statistically different between the two groups. There was no significant difference between the two groups in medical comorbidities,histological grade and lymphatic space involvement. The overall 5-year survival rate and progression-free survival rate of the study group were 92. 59% and 81. 48%,respectively. The 5-year overall survival rate and progression-free survival rate of the control group were 97. 87% and 93. 61%,respectively. The overall survival rate（ χ^2= 8. 983,P = 0. 012） and progression-free survival rate（ χ^2= 14. 533,P〈0. 001） were statistically different between the two groups. The positive results of cytological examination of abdominal irrigation solution were not the factors influencing the overall survival and progression-free survival rate of patients,but the age of onset,pathological type and depth of myometrial invasion were the influencing factors for the overall survival and progression-free survival rate. Conclusion The positive abdominal irrigation solution cytology is not the prognostic factor of early endometrial cancer. However,because the prognosis of patients with positive abdominal irrigation solution cytology is worse than that of negative patients,it is still necessary to do abdominal irrigation solution cytology in clinic and to pay positive attention and take active treatment.