子宫内膜癌复发症状和预后临床研究

Clinical study of recurrent symptoms and prognosis of endometrial cancer

目的探讨子宫内膜癌(endometrial cancer,EC)复发模式和临床特征,以为改善患者预后提供相应建议。方法回顾性研究,选取2013年3月—2017年11月在安阳市妇幼保健院行手术治疗的EC患者271例。通过随访追踪,搜集到237例患者及生存资料,失访34例。被随访患者中,复发患者46例作为复发组,未复发患者191例作为未复发组,对患者各项资料进行比较,归纳EC复发患者的临床表现,分析EC复发患者不接受治疗的影响因素,对EC复发患者的预后进行比较。结果相较于未复发患者,复发患者的年龄更大,高血压发病率高,子宫内膜样癌、浆液性癌及透明细胞癌比例较高,淋巴血管间隙浸润(lymphovascular space invasion,LVSI)阳性比例高,雌激素受体(estrogen receptor,ER)阴性率高、孕激素受体(progesterone receptor,PR)阴性率高、P53蛋白阴性率高、肌层浸润>1/2率高、临床分期Ⅲ与Ⅳ期比例高;EC复发患者共46例,EC复发患者的复发时间为3~19个月,中位时间13个月,41.30%的EC复发患者表现出复发后的临床症状。15.22%的EC复发患者在复发后不愿意接受治疗;手术年龄大、有复发症状以及人均家庭月收入较低是EC患者复发后不愿意接受进一步治疗的显著影响因素(P<0.05);有症状复发患者的术后复发时间为:24(12,36)个月,无症状复发患者的术后复发时间为22(14,34)个月,差异有统计学意义(P<0.05);有症状复发患者的手术后5年总生存时间(overall survival,OS)为84.21%(16/19),无症状复发患者的手术后5年OS为81.48%(22/27),Logrank检验差异无统计学意义(P>0.05);有症状复发患者的手术后5年无进展生存期(progression-free survival,PFS)为63.16%(12/19),无症状复发患者的手术后5年无进展生存期PFS为62.96%(17/27),Logrank检验差异无统计学意义(P>0.05)。结论部分EC患者复发后是有症状的,疼痛是最常见的复发症状。存在复发症状患者复发后的生存时间明显短于无复发症状患者,这可能与部分复发症状患者不愿意接受复发后的治疗有关。

Objective To investigate the clinical characteristics of patients with recurrent endometrial cancer(EC)and provide corresponding suggestions for improving the prognosis of patients.Methods Retrospective study of 271 EC patients who underwent surgical treatment in Anyang Maternal and Child Health Care Hospital from March 2013 to November 2017 were selected.Through follow-up,237 patients and survival data were collected,and 34 cases were lost to follow-up.Among the follow-up patients,46 patients with recurrence were included in the recurrence group,and 191 patients with no recurrence were included in the non-recurrence group.The data of the patients were compared,the clinical manifestations of patients with recurrent EC were summarized,the influencing factors of patients with recurrent EC who did not receive treatment were analyzed,and the prognosis of patients with recurrent EC was compared.Results Compared with patients without recurrence,patients with recurrence were older,had a higher incidence rate of hypertension,higher proportion of endometrioid cancer,serous cancer and clear cell cancer,higher positive proportion of LVSI,higher ER negative rate,higher PR negative rate,higher P53 protein negative rate,higher rate of myometrial infiltration>1/2,and higher proportion of clinical stagesⅢandⅣ.There were 46 patients with recurrent EC,and the recurrence time of recurrent EC patients was 3-19 months,with a median time of 13 months.In the research,41.30%of recurrent EC patients showed clinical symptoms after recurrence,while 15.22%of them were unwilling to receive treatment after recurrence;older surgical age,recurrent symptoms,and lower family monthly income per capita were significant influencing factors for EC patients'unwillingness to receive further treatment after recurrence(P<0.05).The postoperative recurrence time of symptomatic recurrence patients was 24(12,36)months,and the postoperative recurrence time of asymptomatic recurrence patients was 22(14,34)months.The overall survival(OS)of patients with symptomatic recurrence within 5 years after surgery was 84.21%(16/19);the OS of asymptomatic recurrent patients at 5 years after surgery was 81.48%(22/27).Logrank test showed the difference was not statisticant significant(P>0.05).The progression-free survival(PFS)of patients with symptomatic recurrence at 5 years after surgery was 63.16%(12/19);the PFS of asymptomatic recurrent patients at 5 years after surgery was 62.96%(17/27).Logrank test showed the difference was not statistically significant(P>0.05).Conclusion Some patients with EC have symptoms after recurrence.Pain is the most common recurrent symptom.Patients with recurrent symptoms have significantly shorter survival time after recurrence than patients without recurrent symptoms,which may be due to the fact that patients with recurrent symptoms are unwilling to receive treatment after recurrence.