术后辅助化疗在Ⅰ期子宫内膜样腺癌治疗中的价值  

The value of adjuvant chemotherapy in stage Ⅰ endometrioid adenocarcinoma after surgery

作　　者：高敏[1] 王莉[1,2] 蒋国庆[1] 燕鑫[1] 郑虹[1] 王文[1] 高雨农[1] 

机构地区：[1]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所妇科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]石家庄市第四医院,石家庄050011

出　　处：《中国癌症杂志》2009年第4期292-296,共5页China Oncology

摘　　要：背景与目的:Ⅰ期子宫内膜样腺癌患者的预后较好,但仍有少数患者复发,且复发后治疗困难。本研究旨在探讨I期子宫内膜样腺癌患者复发的相关因素及术后辅助化疗在其治疗中的价值。方法:回顾性分析96例Ⅰ期子宫内膜样腺癌患者的临床病理资料,采用Cox回归分析方法探讨与复发相关的预测因素,并分析术后辅助化疗对Ⅰ期子宫内膜样腺癌患者预后的影响。所有患者进行随访,平均随访时间(43.6±24.0)个月。结果:96例Ⅰ期子宫内膜样腺癌患者中10例复发,复发率为10.4%。平均复发时间为(17.3±8.0)个月;其中盆腔复发3例,远处转移6例,盆腔复发并远处转移1例。复发患者的平均年龄为(61.8±6.4)岁,明显高于未复发患者的(53.6±10.1)岁(P=0.015)。复发患者中Ⅰc及G3比例明显高于其他分期及病理分级者(P=0.011,P=0.000)。多因素分析发现:FIGO分期和病理分级是判断复发的重要预测指标(P=0.013,P=0.000)。Ⅰc期患者术后给予辅助化疗者的复发率明显低于未化疗者(P=0.046)。结论:FIGO分期/肌层浸润深度和病理分级是判断复发的重要预测指标;术后辅助化疗有助于降低Ⅰc期子宫内膜样腺癌患者的复发率。Background and purpose： The prognosis of patients with FIGO stage I endometrioid adenocarcinoma is good, although the local control is high, some patients are not sensitive to the treatment and relapse. This paper was to explore the prognostic factors associated with recurrence and assess the efficacy of adjuvant chemotherapy in patients with the FIGO stage I endometrioid adenocarcinoma. Methods： A retrospective analysis of 96 patients with FIGO stage I endometrioid adenocarcinoma was performed. All patients underwent surgery, of which 17 patients underwent adjuvant chemotherapy. Multivariate analysis was performed for the prognostic factors and actuarial techniques were used for recurrence rates. All the patients were followed up and the mean time of follow-up was 43.6±24.0 months. Results： Ten of 96 cases with FIGO stage I endometrioid adenocarcinoma were recurrent and the recurrence rate was 10.4%. The median time of recurrence was 17.3±8.0 months. The median age was 61.8±6.4 years in recurrent patients, which was higher than that of patients without recurrence （P=0.015）. In recurrent patients, the percentages of stage Ie and G3 were higher than those of other stages and histological grades （P=0.011, P=0.000）. Multivariate analysis showed that FIGO stage and histological grade were significant prognostic factors （P=0.013, P=0.000）. The recurrent rate in patients with FIGO stage Ic who had received postoperative adjuvant chemotherapy was significantly lower than that of patients who had not undergone adjuvant.chemotherapy （P=0.046）. Conclusion： FIGO stage/depth of myometrial invasion and histological grade were important prognostic factors in FIGO stage endometrioid adenocarcinoma. It is possible that postoperative adjuvant chemotherapy might decrease the recurrence and improve the prognosis in patient with stage Ic.

关 键 词：子宫内膜样腺癌 辅助化疗 复发 

分 类 号：R737.33[医药卫生—肿瘤] R730.53[医药卫生—临床医学]