子宫内膜浆液性癌与高级别癌的预后生存比较(附70例临床分析)

Survival Outcomes of Uterine Serous Carcinoma and Grade 3 Endometrioid Carcinoma:Clinical Analysis of 70 Patients

目的:探讨子宫内膜浆液性癌(uterine serous carcinoma,USC)与高级别癌(grade 3 endometrioid carcinoma,G3EC)的预后差异。方法:回顾分析2012年7月至2018年1月于四川省肿瘤医院初次接受治疗的70例Ⅰ~Ⅳ期USC与G3EC患者的临床病理资料。使用Kaplan-Meier法构建生存曲线估计总生存率(overall survival,OS)和无进展生存率(progression-free survival,PFS)的差异,使用单因素和COX多因素回归分析影响患者预后的因素。结果:相较G3EC患者,USC患者5年生存率低(54.8%vs 84.6%,P=0.006)且肿瘤复发转移风险高(35.5%vs 10.3%,P=0.035),单因素分析显示,病理类型为USC、腹腔冲洗液细胞学阳性、原发灶超出子宫体、未获得满意减瘤手术、中晚期肿瘤是影响两组患者PFS及OS的不良预后因素。多因素分析显示,原发灶超出子宫体是两组患者PFS和OS的独立不良预后因素[风险比(95%置信区间)分别为19.48(1.86~204.00)和10.49(1.70~64.90)]。结论:USC更易发生远处转移,USC患者较G3EC患者总体预后差,原发灶超出子宫体是两组患者进展与生存的独立不良预后因素。

Objective:To compare the prognosis of patients with uterine serous carcinoma(USC)and that of patients with grade 3 endometrioid carcinoma(C3EC).Methods:The clinical and pathological data of 70 patients with stage I~IV USC and G3EC first treated in Sichuan Cancer Hospital from July 2012 and January 2018 were retrospective studied.Kaplan-Meier method was used to estimate overall survival(OS)and progression-free survival(PFS).Factors influencing patient outcomes were estimate using univariate and COX multivariate regression.Results:USC patients had a lower 5-year survival rate(54.8%us 84.6%,P=0.006)and a higher risk of tumor recurrence and metastasis(35.5%us 10.3%,P=0.035)compared with G3EC patients.Univariate analysis showed that histology type in USC,positive peritoneal washing cytology,extra-uterine disease,suboptimal cytoreductive surgery and advanced stage were adverse factors affecting PFS and OS.Multivariate analysis showed that extra-uterine disease was an independent adverse prognostic factor for USC and C3EC patients[PFS:HR(95%CI)=19.48(1.86~204.00);OS:HR(95%CI)=10.49(1.70~64.90)].Conclusion:USC is more prone to distant metastasis,the overall prognosis of USC patients is worse than that of patients with G3EC.Extra-uterine disease is an independent adverse prognostic factor for USC and G3EC patients.