卵巢子宫内膜样癌同步子宫内膜病变的临床分析

Clinical and prognostic features of ovarian endometrioid carcinoma with synchronous endometrial lesions

目的探讨卵巢子宫内膜样癌(OEC)同步子宫内膜病变的临床特点、治疗及预后。方法收集1998年8月至2017年12月在北京大学人民医院接受治疗并经病理检查确诊为OEC的56例患者的临床病理资料,其中OEC同步子宫内膜病变患者13例(OEC同步内膜病变组)及单纯OEC患者43例(单一OEC组)。比较两组患者的临床特点、治疗方案、术后病理及预后。结果56例OEC患者中,同步发生子宫内膜病变的比例为23%(13/56)。与单一OEC组比较,OEC同步内膜病变组患者的确诊年龄[分别为(52.7±10.2)、(44.9±8.3)岁]、已绝经的比例[分别为53%(23/43)、2/13]、有高血压病史的比例[分别为28%(12/43)、0/13]降低,两组分别比较,差异均有统计学意义(P<0.05);而两组患者的初潮年龄、手术前后血清CA125水平以及有痛经史、未生育、有子宫内膜异位症(内异症)病史、有糖尿病病史的比例分别比较,差异均无统计学意义(P>0.05)。OEC同步内膜病变组、单一OEC组患者的首发症状为不规则阴道流血的比例分别为5/13、9%(4/43),两组比较,差异有统计学意义(χ^(²)=6.292,P=0.012)。两组患者的手术病理分期、病理分级、肿瘤最大径、肿瘤发生侧别、腹水量、转移部位、卵巢肿瘤病理切片中是否出现内异症病灶、手术方式、是否行腹主动脉旁淋巴清扫术、术后化疗方案、化疗疗程数分别比较,差异均无统计学意义(P>0.05)。OEC患者的整体5年生存率为91.6%,整体5年无进展生存率为76.6%,其中OEC同步内膜病变组、单一OEC组患者的5年生存率分别为80.2%、93.4%,5年无进展生存率分别为74.1%、77.3%,两组分别比较,差异均无统计学意义(P>0.05)。多因素分析显示,影响OEC患者预后的独立危险因素为手术病理分期(P=0.006)及残留灶大小(P=0.020)。结论OEC患者中同步发生子宫内膜病变的比例较高;OEC同步子宫内膜病变患者较单纯OEC患者年轻,首发症状为不规则阴道流血者多见;OEC是否同步子宫内膜病变并不影响其预后。

Objective To compare the clinical and prognostic characteristics of ovarian endometrioid carcinoma(OEC)patients with synchronous endometrial lesions and patients with pure OEC.Methods A retrospective review of the medical records of patients received initial treatment and a postoperative pathological diagnosis of OEC at Peking University People′s Hospital between August 1998 and December 2017 were performed.According to the inclusion criteria,a total of 56 patients with OEC were included in the study,including 13 patients concurrent with simultaneous endometrial lesions(Group A)and 43 patients with pure OEC(Group B).Results Patients with synchronous endometrial lesions accounted for 23%(13/56).Mean age of Group A at diagnosis was(44.9±8.3)years old,2/13 of patients were postmenopausal,and no one had a history of hypertension,the first symptom of 5/13 people was irregular vaginal bleeding.Mean age of Group B patients at diagnosis was(52.7±10.2)years old,53%(23/43)of patients were postmenopausal,and 28%(12/43)patients had the history of hypertension,the first symptom of 4(9%,4/43)people was irregular vaginal bleeding.The differences of age,menopause status,history of hypertension and initial symptoms between the two groups were statistically significant(all P<0.05).There were no significant differences in fertility history,dysmenorrhea history,age of menarche,history of endometriosis,preoperative and postoperative CA125 level,International Federation of Gynecology and Obstetrics(FIGO)stage,tumor grade,metastatic site and platinum-based chemotherapy drug resistance between the two groups(all P>0.05).The overall 5-year survival rate of OEC patients was 91.6%,and the overall 5-year progression-free survival rate was 76.6%.Among them,the 5-year survival rate of the OEC concurrent with simultaneous endometrial lesions group was 80.2%,and the pure OEC group was 93.4%;the 5-year progression-free survival rate of the OEC concurrent with simultaneous endometrial lesions group was 74.1%,and the 5-year progression-free survival rate of the pure OEC group was 77.3%.There were no significant differences between the two groups(all P>0.05).Multivariate analysis showed that the independent factors for the prognosis of OEC patients were FIGO stage(P=0.006)and residual lesion size(P=0.020).Conclusions OEC patients have a high proportion of simultaneous endometrial lesions.OEC with simultaneous endometrial lesions are younger than patients with pure OEC.Synchronous endometrial lesions do not affect the prognosis of patients with OEC.