国际妇产科学杂志

国际妇产科学杂志 ›› 2016, Vol. 43 ›› Issue (4): 442-445.

• 论著 • 上一篇    下一篇

低分化子宫内膜样腺癌分型归属探讨

郑泽纯，李小毛   

  1. 510630 中山大学附属第三医院妇科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2016-08-15 发布日期:2016-08-15
  • 通讯作者: 李小毛

Grade 3 Endometrioid Endometrial Carcinoma Maybe Considered as TypeⅡ Endometrial Carcinomas

ZHENG Ze-chun, LI Xiao-mao   

  1. Department of Gynecology，The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2016-08-15 Online:2016-08-15
  • Contact: LI Xiao-mao

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摘要： 目的：探讨低分化子宫内膜样腺癌分型归属问题。方法：收集2000年1月1日—2010年12月31日广东省妇幼安康工程子宫内膜癌防治项目医院高分化和中分化子宫内膜样腺癌（grade 1 and grade 2 endometrioid endometrial carcinoma，G1EEC/G2EEC）4 026例，低分化子宫内膜样腺癌（grade 3 endometrioid endometrial carcinoma，G3EEC）619例，子宫浆液性腺癌（uterine serous carcinoma，USC）和透明细胞癌（clear cell carcinoma，CCC）166例，进行回顾性分析，比较3组患者的临床病理特征和预后，探讨G3EEC分型归属问题。结果：①G3EEC组与USC+CCC组的超重/肥胖（40.6% vs. 37.7%，P=0.625）以及未产的比例（4.2% vs. 2.5%，P=0.323）相比较差异无统计学意义，且低于G1EEC/G2EEC组；G3EEC组与USC+CCC组的绝经患者（64.1% vs. 70.5%，P=0.127）、首发症状为腹痛和腹胀（4.7% vs. 6.0%，P=0.481）以及手术病理分期为晚期患者的比例（32.8% vs. 31.3%，P=0.720）相比较差异均无统计学意义，且高于G1EEC/G2EEC组。②G3EEC组与USC+CCC组肿瘤局限于宫腔下部（14.1% vs. 18.1%，P=0.279）、深肌层浸润（43.6% vs. 39.8%，P=0.372）、淋巴血管间隙受累（9.4% vs. 11.4%，P=0.425）、宫颈间质侵犯的比例（23.6% vs. 21.7%，P=0.607）以及盆腔淋巴结转移率（24.7% vs. 24.3%，P=0.927）相比较差异无统计学意义，且高于G1EEC/G2EEC组。③G3EEC组与USC+CCC组的生存时间和无进展生存时间比较差异无统计学意义（P分别为0.544和0.939）。Cox回归分析显示，G3EEC组的生存时间（HR=4.147，95%CI：2.573~6.683，P＜0.001）和无进展生存时间（HR=3.365，95%CI：2.300~4.923，P＜0.001）低于G1EEC/G2EEC组。结论：G3EEC与USC及CCC有相似的临床病理特征及预后，而不同于G1EEC/G2EEC，低分化子宫内膜样腺癌归为Ⅱ型子宫内膜癌更为合理。

Abstract: Objective：To determine whether grade 3 endometrioid endometrial carcinoma (G3EEC) could be more akin to type Ⅰ or Ⅱ cancer. Methods：Between January 2000 and December 2010，4 811 patients were extracted from the collaboration hospitals in the center for endometrial cancer control and presentation in Guangdong, China. We performed a retrospective study of clinicopathological parameters and survival data in three different populations including grade 1 and grade 2 endometrioid endometrial carcinoma (G1EEC/G2EEC, n=4 026), G3EEC (n=619), uterine serous carcinoma and clear cell carcinoma（USC/CC, n=166). Results: In G3EEC group and USC+CCC group, propotion of obese and fatty women（40.6% vs. 37.7%, P=0.625）, propotion of nulparity(4.2% vs. 2.5%, P=0.323), percentage of menopause（６4.1% vs. 70.5%，P=0.127）, percentage of abodominal symptoms(4.7% vs. 6.0%, P=0.481), percentage of advanced surgical stage（３２.8% vs. 31.3%, P=0.7２） were assemblｅd，and there was a significant difference while compared to G1EEC/G2EEC. G3EECs shared similar pathological features including percentage of lower uterine segment involvement（１4.1% vs. 18.1%，P=0.279）, deep myometrial invasion （43.6% vs. 39.8%，P=0.372), invasion of lymph-vascular spaces(9.4% vs. 11.4%，P=0.425), incidence rates of cervical stromal invasion(23.6% vs. 21.7%，P=0.607) and lymph node metastasis incidence(24.7% vs. 24.3%，P=0.927), higher than G1EEC/G2EECs . There was no significant difference in overall survival(P=0.544) and progress free survival(P=0.939) for G3EECs and USCs/CCCs. Using a Cox regression analysis, G3EECs had a significantly decreased overall survival and progress free survival compared to G1EEC/G2EECs [HR=4.147，95%CI(2.573-6.683)，P＜0.001；HR=3.365，95%CI(2.300-4.923)，P＜0.001]. Conclusions：According to clinicopathologic features and outcome, G3EEC may be better characterized as type Ⅱendometrial cancer.