手术前后危险分层不一致的子宫内膜癌患者的临床特征及预后分析

Clinicopathological and prognostic analysis of endometrial carcinoma patients with inconsistent risk stratification before and after surgery

目的探究术前分段诊断性刮宫病理及术后标本病理结果存在差异所导致的危险分层不一致的子宫内膜癌患者的临床特征及预后相关因素。方法选取353例行手术治疗的子宫内膜癌患者,收集患者的病历资料。结合术前分段诊断性刮宫病理与术后标本病理结果,对手术前后子宫内膜癌患者危险分层的变化及不同分组临床特征与预后情况进行分析。结果 353例子宫内膜癌患者中,149例(42.21%)患者手术前后病理组织学分级及病理学分型不完全相符,55例(15.58%)患者手术前后的危险分层不一致,其中,40例患者术前危险分层为低危子宫内膜癌,而术后危险分层为高危子宫内膜癌。术后高危子宫内膜癌患者预后较差。结论子宫内膜癌术前分段诊断性刮宫病理结果的准确性较低,子宫内膜癌患者的分期手术是必要的。

Objective To study the clinical characteristics and prognostic factors of endometrial carcinoma with inconsistent risk stratification assessed using different pathological specimens obtained from preoperative fractional diagnostic curettage and post-operative specimens. Method The medical data of 353 patients with endometrial carcinoma treated surgically were analyzed retrospectively. Based on the comprehensive evaluation of pathological results of preoperative fractional curettage and post-operative specimens, the changes of risk stratification of endometrial carcinoma before and after surgery and the clinical characteristics and prognosis of in different groups were compared. Result Among the 353 cases with endometrial carcinoma, 149 cases(42.21%) had only partially consistent preoperative and postoperative pathological classification, and 55 cases(15.58%) were observed with complete inconsistency regarding their pre-and post-operative risk stratifications, including 40 cases of preoperative risk stratification as low-risk endometrial carcinoma and postoperative high-risk endometrial carcinoma. Post-operative high-risk endometrial carcinoma was associated with poor prognosis after surgery. Conclusion Preoperative fractional curettage is of relatively low accuracy as the preoperative diagnosis for endometrial carcinoma, so it is necessary to perform surgical staging surgery for endometrial carcinoma.