子宫浆液性癌101例临床分析  

Clinical analysis of 101 cases of uterine serous carcinoma

作　　者：李小毛[1] 郑泽纯[1] 叶辉霞[1] 马利国 刘继红[3] 林仲秋[4] 

机构地区：[1]广州中山大学附属第三医院妇产科,510630 [2]深圳市人民医院 [3]广州中山大学附属肿瘤医院 [4]中山大学附属第二医院

出　　处：《中国妇产科临床杂志》2015年第1期26-29,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：国家自然科学基金(30772332);广东省自然科学基金(S2012010008640);广东省科技计划项目(20100309);广东省妇幼安康工程--子宫内膜癌防治项目(2010)

摘　　要：目的探讨子宫浆液性癌的临床病理特征和预后影响因素。方法回顾性分析2000年1月至2010年12月广东省子宫内膜癌防治项目101例子宫浆液性癌的临床病理特征及预后。结果子宫浆液性癌占同期子宫内膜癌的1.7%,患者的发病平均年龄(56.2±10.3)岁,多发于绝经后妇女(67.3%)。子宫浆液性癌术前的误诊率较高(74.7%),容易与低分化子宫内膜样腺癌混淆。术前CA125升高的患者多数为晚期(72.4%)。临床Ⅰ期患者术后分期升级占38.1%。无肌层浸润的患者中发生子宫外转移占38.5%。深肌层浸润占35.6%;淋巴血管间隙受累占16.8%;淋巴结转移占29.7%,其中无/浅肌层浸润占47.4%。86.2%的患者p53呈阳性。术后复发以远处转移为主,占77.3%(17/22)。子宫浆液性癌的5年总体生存率和5年无进展生存率分别为74.9%和67.9%;多因素分析显示,淋巴结转移是影响子宫浆液性癌总体生存率和无进展生存率的独立因素(P=0.015,P=0.001)。结论子宫浆液性癌发病年龄较大,多见于绝经后女性,术前病理误诊率高,易于发生子宫外转移,术前CA125升高对预测子宫外转移有一定意义。p53阳性是其重要的分子生物学特征。复发以远处转移为主,淋巴结转移是预后的重要影响因素。Objective The aim of this study was to identify the clinical and pathologic characteristics and the survival of patients with uterine serous carcinoma （USC）. Methods One hundred and one patients with USC who were surgically staged in endometrial cancer prevention projects in Guangdong Province between January 2000 and December 2010 were identified. Retrospective data review was performed to investigate clinical and pathologic char- acteristics and the survival of patients. Results USC made up 1.7 % of endometrial cancer in this study. The mean age at the time of diagnosis was （56.2 ±10.3） years old. Most tumors occured in postmenopausal women （67.3%）. The rate of misdiagnosis before surgery was high （72. 4%） with a tendency to be misdiagnosed as grade 3 endometrioid carcinoma. Most USC patients with a high level of CA12swere in advanced stage. 38.5% of Clinical stage I patients upstaged after surgery. 38. 5% of US（; patients with no muscular invasion had extrauterine inva- sion. 35.6% of US（2 had deep myometrial invasion, 16.8% had lymph vascular space invasion and 29.7% had lymphnode invasion, while 47.4% of them had no or superficial muscular infiltration. 86.2% of patients showed ex- pression of p53. Most recurrent disease involved distant sites （77.3%, 17/22）. Its five- year overall survival rate and progress free survival rate were 74.9% and 67.9%. In a multivariate analysis, lymph node positivity was asso- ciated with a poor prognosis （OS： P=0. 015; PFS： P=0. 001）. Conclusions The age of USC patients was older, and most were post - menopause. The rate of misdiagnosis before surgery on USC was high. It had a tendency of extrauterine metastasis. The detection of CA125 before surgery was meaningful to predict extrauterine metasta- sis. The expression of p53 was its important molecular biological feature. Recurrence occurred especially in distant sites.Lymph node metastasis was an important prognostic lactor.

关 键 词：子宫内膜癌 浆液性癌 淋巴结 预后 

分 类 号：R737.33[医药卫生—肿瘤]