| | | | | 特殊类型子宫内膜癌的临床特点 | | | 马绍康;吴令英;高菊珍 | | | 目的比较特殊类型子宫内膜癌——浆液性乳头状腺癌(UPSC)和透明细胞癌(CCC)与低分化内膜腺癌(G3EC)的临床特点及生存率。方法回顾性分析22例UPSC和17例CCC的临床资料,并随机取31例同期治疗的G3EC进行比较分析。结果UPSC、CCC和G3EC的中位发病年龄相似,分别为59、59和56岁。UPSC、CCC患者的晚期患者(~期)的比例高于G3EC晚期患者的比例(50.0%、41.2%和22.6%,P<0.05)。UPSC及CCC患者CA125(>35U/ml)升高的比例高于G3EC患者(50.0%、47.1%和29.0%,P<0.05)。UPSC患者的腹腔液细胞学阳性率高于CCC和G3EC患者(36.4%和11.7%、9.7%,P<0.05)。70例患者中,65例接受了术后治疗,包括单纯放疗33例,放疗联合化疗26例,单纯化疗16例,5例患者无术后辅助治疗。22例UPSC患者的复发率为36.4%(8/22),其中以远处血行转移最常见,达62.5%(5/8),2例盆腔及阴道残端复发的患者均为术后单纯化疗的患者,复发率为25.0%(2/8)。复发患者总的中位生存8个月(6~24个月),2年生存率12.5%;17例CCC患者的复发率为29.4%(5/17),复发患者总的中位生存6个月(1~13个月),2年生存率0%;31例G3EC患者的复发率为19.4%(6/31),4例盆腔复发均为术后行孕激素治疗或单纯化疗的患者,盆腔复发率达40.0%(4/10),2例远处转移,为术后单纯盆腔放疗的患者,转移率为14.3%(2/14),中位生存7个月(6~25个月),2年生存率33.3%。UPSC和CCC患者的复发率高于G3EC患者(36.4%、29.4%和19.4%,P<0.05)。UPSC和CCC患者更容易发生盆腔外转移如腹腔、血行转移(P<0.05)。三者的5年生存率分别为30.5%、34.0%和70.7%,UPSC和CCC的预后明显差于G3EC(P<0.01)。结论UPSC和CCC的临床特点和预后与G3EC患者不同,术后辅助治疗应区别对待。
【作者单位】：中国医学科学院中国协和医科大学肿瘤医院妇瘤科 北京100021
【关键词】：子宫肿瘤;癌,乳头状;腺癌,透明细胞;子宫内膜肿瘤;预后;复发;存活率分析
【分类号】：R737.33
【DOI】：CNKI:SUN:SYZZ.0.2008-02-022
【正文快照】：
多数子宫内膜癌为早期、分化好的子宫内膜样腺癌,预后好。但子宫内膜浆液性乳头状腺癌(uterine papillary serous carcinoma UPSC)、透明细胞癌(clear cell carcinoma CCC)和低分化内膜样腺癌(grade3endometrioid carcinoma G3EC)的预后差,UPSC和CCC容易发生子宫外转移而且预后 | | |  推荐 CAJ下载  PDF下载 | | | CAJViewer7.0阅读器支持所有CNKI文件格式，AdobeReader仅支持PDF格式 | | | | Clinical features of special types of uterine endometrial carcinoma | | | MA Shao-Kang;WU Ling-Ying;GAO Ju-Zhen (Caner Hospital;Peking Union Medical College;Chinese Academy of Medical Sciences;Beijing;100021;China) | | | Objective To compare the clinical features and survival of special types of uterine endometrial carcinoma. Methods Medical records of 22 cases of uterine papillary serous carcinoma (UPSC), 17 cases of clear cell carcinoma (CCC) and 31 cases of grade 3 endometrioid uterine carcinoma (G3EC) were retrospectively reviewed. The survival data were analyzed using Kaplan-Meier curve. Results A higher proportion of UPSC and CCC patients had stage Ⅲ~Ⅳ disease compared to G3EC (63.6% and 41.2% vs 22.6%). The proportion of cases with elevated CA125 (>35 U/ml) in UPSC and CCC was higher than that in G3EC (50.0% and 47.1% vs 29.0%). There was higher positive rate of peritoneal cytology in UPSC than that in CCC and G3EC (36.4% vs 11.7% and 9.7%). Sixty-five of 70 patients underwent adjuvant treatment after operation, including radiotherapy in 33, chemotherapy in 16, and combined radiotherapy and chemotherapy in 16. Eight patients recurred in 22 with UPSC with a recurrent rate of 36.4%, the most common recurrence was distant metastasis (62.5%, 5/8). Two patients with pelvis and vagina recurrence were treated by chemotherapy postoperation alone (2/8). The median survival was 8 months (6~24 months), the 2-year survival rate was 12.5%. Five patients recurred in 17 with CCC with a recurrent rate of 29.4%. The median survival time was 6 months (1~13 months), the 2-year survival rate was 0%. Six patients recurred in 31 with G3EC with a recurrent rate of 19.4%; 4 patients with pelvis and (or) vagina recurrence were all treated by chemotherapy or progesterone alone; the pelvic recurrent rate was 40.0% (4/10). Two patients suffered from distant metastasis who were treated by postoperative pelvic radiotherapy with a distant metastasis rate of 14.3% (2/14); the median survival time was 7 months (6~25 months) and the 2-year survival rate was 33.3%. There was no significance difference in median survival time of recurrent patients with UPSC, CCC and G3EC. The recurrent rate of UPSC and CCC was higher than that of G3EC (36.4% and 29.4% vs 19.4%). There were more patients of UPSC and CCC suffered from out pelvis and distant metastasis than those of G3EC. The 5-year survival for women with UPSC, CCC and G3EC were 30.5%, 34.0% and 70.7%, respectively (P<0.05). Conclusions Women with UPSC and CCC have a difference clinical features from those of G3EC, and the prognosis of UPSC and CCC is poorer than that of G3EC.
【Keyword】：uterine neoplasms;carcinoma,papillary;adenocarcinoma,clear cell;endometrial neoplasms;prognosis;recurrence;survival analysis |
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