子宫乳头状浆液性癌临床病理分析及其辅助疗法探讨  

Clinicopathologic study on 61 cases of uterine papillary serous carcinoma with or without adjuvant therapy

作　　者：薛德彬[1] 丁丽娟[2] 夏爱丽[2] 陈东[3] 夏华萍[3] 滕晓东[4] 徐少婷[5] 章锁江[6] 任兴昌[1] 

机构地区：[1]浙江省宁波市妇女儿童医院病理科 杭州市中医院病理科,315012 [2]妇产科,浙江省宁波市妇女儿童医院315012 [3]浙江省宁波市妇女儿童医院病理科,315012 [4]浙江大学医学院附属第一医院病理科 [5]浙江大学医学院附属第一医院妇产科 [6]浙江大学医学院附属妇产医院病理科

出　　处：《中华病理学杂志》2010年第10期671-674,共4页Chinese Journal of Pathology

基　　金：宁波市科技局社会发展攻关项目（2006C100058）

摘　　要：目的 探讨子宫乳头状浆液性癌的临床病理特点及其合理疗法,以提高对该病的认识.方法 收集61例子宫乳头状浆液性癌,全面手术病理分期并随访4～9年,采用HE和免疫组织化学（EnVision法）染色,进行镜下观察,结合术后治疗方案和随访资料进行临床病理分析.结果 61例患者均为绝经后妇女,中位年龄68岁,临床表现为绝经后阴道流血和（或）腹部症状,或宫颈细胞学筛查发现异常等.肿瘤直径中位数7.5 cm（范围1.2～14.8 cm）,FIGO分期：Ⅰ期17例（27.9%;Ⅰ A期8.2%,Ⅰ B期14.8%,Ⅰ C期4.9%）,Ⅱ、Ⅲ和Ⅳ期分别占9.8%（6/61）、32.8%（20/61）和29.5%（18/61）.活检和手术标本的组织学特点与卵巢高级别浆液性乳头状癌相似,以高级别核为特征,常出现复杂的分支状乳头状结构,沙砾体出现率24.6%（15/61）,免疫组织化学染色示p53和Ki-67弥漫强阳性而雌激素受体（ER）和孕激素受体（PR）阴性（均为肿瘤细胞核着色）.24.6%（15/61）未见子宫肌层浸润,但其中10/15有子宫外扩散,主要累及腹膜（6/15）和淋巴结转移（9/15）.深肌层浸润、淋巴结转移和脉管受累为单个预后差的指标.56例接受术后辅助治疗,化疗者42例,放疗者24例,联合放/化疗10例.化疔组和未化疗组（用或不用放疗）的中位生存期分别为66.4和32.8个月.结论 子宫乳头状浆液性癌有独特的临床和病理特征,分期、淋巴结状况、脉管受累和肌层浸润深度为主要预后指标.晚期患者和复发患者采用含有紫衫醇（单用或联合使用顺铂）的全身化疗方案,可延长患者生存期.Objective To study the clinicopathologic features of uterine papillary serous carcinoma （UPSC） and the roles of adjuvant therapy. Methods Sixty-one cases of UPSC with operation done and followed up for a period of 4 to 9 years were enrolled into the study. The histology of slides specimens were reviewed and immunohistochemical study was performed. The follow-up and survival data were analyzed.Results All of the 61 patients were post-menopausal, with a median age of 68 years. The clinical presentations included abnormal vaginal bleeding, abdominal symptoms and abnormal Pap smears. The median size of the tumors was 7. 5 cm （ range = 1.2 to 14. 8 cm）. There were 27.9% cases in FIGO stageⅠ（8.2% in stageⅠA, 14. 8% in stage ⅠBand4.9% in stage ⅠC）, 9. 8% in stage Ⅱ, 32. 8% in stage Ⅲ and 29. 5% in FIGO stage Ⅳ.The histologic features were similar to those of the ovarian counterpart, with tumor cells containing the high-grade nuclei and arranged in complex papillae. Psammoma bodies were identified in 24. 6% of the cases. Immunohistochemical study showed that the tumor cells demonstrated diffuse and strong nuclear staining for p53 and Ki-67. They were negative for estrogen receptorand progesterone receptor. Fifteen of the 61 cases （24. 6% ） showed no evidence of myometrial invasion.However, ten of the 15 cases had extrauterine disease, with peritoneal （6/15） and nodal （9/15）involvement. Tumors with deep myometrial invasion, lymphovascular permeation and nodal metastasis were associated with worse prognosis by univariate analysis. Fifty-six patients received adjuvant therapy. The number of patients receiving adjuvant chemotherapy alone, adjuvant radiotherapy alone and combined adjuvant chemotherapy/radiotherapy were 42, 24 and 10, respectively. The median survivals of the chemotherapy group and non-chemotherapy group （ with or without radiotherapy） were 66. 4 months and 32. 8 months, respectively. Conclusions UPSC has distinctive clinical and pathologic features. The tumor stage, l

关 键 词：子宫肿瘤 化学疗法 辅助 预后 

分 类 号：R686[医药卫生—骨科学]