合并腺肌病对子宫内膜癌临床病理特征及预后的影响

The Effect of Adenomyosis on Pathological Characteristics and Prognosis in Endometrial Cancer

目的:研究合并子宫腺肌病的子宫内膜癌患者肿瘤肌层浸润深度、手术病理分期、淋巴结转移等临床病理特征,并探讨其对复发及预后的影响。方法:对2012年9月—2015年9月期间在我院接受手术治疗的528例子宫内膜癌患者的临床病理资料进行回顾性分析。根据术后子宫标本是否合并子宫腺肌病分为两组:合并子宫腺肌病组(106例,20%)、单纯的子宫内膜癌组(422例,80%)。分析并比较两组患者手术病理分期和组织分级、病理类型、肌层浸润深度、淋巴脉管间隙浸润、淋巴结转移等临床特点,以及复发率、5年无病存活率、5年总存活率等预后指标。结果:与单纯的子宫内膜癌组相比,合并子宫腺肌病组患者年龄较低,肿瘤分期较早,组织分化程度高,肌层浸润较浅,复发率低,5年无病存活率、总存活率高(P<0.05)。而其他指标如组织病理类型、淋巴结转移、淋巴脉管间隙浸润、腹水细胞学阳性率的比较差异无统计学意义(P>0.05)。结论:合并子宫腺肌病与子宫内膜癌的分期较早、组织分化程度高、浅肌层浸润显著相关,可能是子宫内膜癌良好预后的预测因素。

Objective:To examine the effects of adenomyosis on pathological characteristics such as myometrial tumor invasion,stage of the disease,and survival in endometrial cancer.Methods:A retrospective study was conducted among endometrial cancer patients who underwent surgery in our hospital from September 2012 to September 2015.The patients were divided into 2 groups,adenomyosis group(n=106,20%)and nonadenomyosis group(n=422,80%),according to the presence/absence of uterine adenomyosis.Stage,histopathological grade,muscle invasion,lymphovascular space invasion and lymph node status were compared,and recurrence rate,5-year disease-free survival,5-year overall survival were analysed.Results:Compared with the nonadenomyosis group,the adenomyosis group was significantly associated with lower age,lower FIGO stage,a higher grade of differentiation,a lower MI than those without adenomyosis(P<0.05).In survival analysis,endometrial cancer coexisting with adenomyosis was associated with a significantly lower recurrence rate,better 5-year disease-free survival and overall survival.Conclusion:Adenomyosis appears to be associated with early stage,high degree of tissue differentiation and superficial myometrial invasion of endometrial cancer,suggesting that coexisting with adenomyosis may be considered as a good prognostic factor for endometrial cancer.