早期子宫内膜癌患者腹水细胞学检查阳性的危险因素及其对预后的影响  

Prognostic Ef ect of Positive Peritoneal Cytology in Early Stage Endometrial Cancer

作　　者：李小毛[1] 杨晓辉[1] 叶辉霞[1] 杨越波[1] 叶敏娟[1] 

机构地区：[1]中山大学附属第三医院,广东广州510630

出　　处：《实用妇产科杂志》2015年第8期591-595,共5页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金(编号:30772332);广东省自然科学基金(编号:S20120100086);广东省妇幼安康工程-子宫内膜癌防治项目

摘　　要：目的：探讨早期子宫内膜癌患者腹水细胞学检查阳性的危险因素及其对早期子宫内膜癌预后的影响。方法：对2000-2010年广东省妇幼安康工程子宫内膜癌防治项目医院收集到的3415例Ⅰ-Ⅱ期子宫内膜癌患者行腹水细胞学检查,分析其腹水细胞学检查阳性与临床病理情况的关系及腹水细胞学检查阳性与患者预后的关系。结果：1早期子宫内膜癌患者中腹水细胞学检查阳性率为3.7%。2单因素分析显示发病年龄〉60岁（P=0.008）、深肌层浸润（P=0.001）、宫颈间质侵犯（P=0.007）是早期子宫内膜癌腹水细胞学检查阳性的影响因素;多因素分析显示发病年龄（OR=1.797,95%CI 1.064-3.036,P=0.028）、深肌层浸润（OR=1.724,95%CI 1.025-2.900,P=0.040）、宫颈间质侵犯（OR=2.051,95%CI 1.083-3.886,P=0.027）是早期子宫内膜癌腹水细胞学检查阳性的独立危险因素。3腹水细胞学检查阳性和阴性患者的复发率（14.2%vs 7.2%,P=0.005）、远处复发率（11.0%vs 4.5%,P=0.001）差异有统计学意义,局部复发率（3.1%vs 2.9%,P〉0.05）差异无统计学意义。4腹水细胞学阳性和阴性患者的生存时间及无进展生存时间比较,差异均有统计学意义（P〈0.001,P=0.001）。多因素分析显示,腹水细胞学检查阳性对生存时间（OR=0.620,95%CI 0.194-1.986,P=0.421）和无进展生存时间（OR=0.496,95%CI 0.182-1.348,P=0.169）无明显影响。结论：腹水细胞学检查阳性与高龄、深肌层浸润、宫颈间质侵犯等危险因素密切相关。腹水细胞学检查阳性患者的预后比阴性患者差,但腹水细胞学检查阳性并不是早期子宫内膜癌的独立预后影响因素。Objective： To evaluate the prognostic effects of positive peritoneal cytology in early stage endometrial cancer. Methods： We retrospectively analyze clinical pathologic data of 3 415 patients who were diagnosed with endometrial cancer from 2000 to 2010 in 64 hospitals of endometrial cancer prevention projects in Guangdong Province. The relationship of positive peritoneal cytology and clinicopathologic features,and prognosis in early stage endometrial cancer were analyzed. Results： 1 Rate of positive peritoneal cytology in early stage endometrial cancer is 3. 7%. 2 Univariate analysis revealed that age 60 years（ P = 0. 008）,deep myometrial invasion（ P =0. 001）,cervical stromal invasion（ P = 0. 007） were high risk factors of positive peritoneal cytology in early stage endometrial cancer. Multi-variate analysis revealed that age60 years（ OR = 1. 797,95% CI 1. 064-3. 036,P = 0. 028）,deep myometrial invasion（ OR = 1. 724,95% CI 1. 025-2. 900,P = 0. 040）,cervical stromal invasion（ OR = 2. 051,95% CI 1. 083-3. 886,P = 0. 027） were significant high risk factors of positive peritoneal cytology in early stage endometrial cancer. 3The relapse rate（ 14. 2% vs. 7. 2%; P = 0. 005） and distant relapse rate（ 11. 0% vs. 4. 5%; P = 0. 001） showed statistically significance between positive and negative peritoneal cytology patients,while the local relapse rate（ 3. 1% vs. 2. 9%; P〈0. 05）showed no statistically difference between them. 4The overall survival and progression-free survival between positive and negative peritoneal cytology patients were statistically significance（ P〈0. 001,P = 0. 001）. Multivariate analysis revealed that there were no statistically difference between positive and negative peritoneal cytology patients in overall survival（ OR =0. 620,95% CI 0. 194- 1. 986,P = 0. 421） and progression-free survival（ OR = 0. 496,95% CI 0. 182- 1. 348,P =0. 169）. Conclusions： Positive peritoneal cytology is associated with high risk factors such as deep myometrial

关 键 词：子宫内膜癌 腹水细胞学 预后 

分 类 号：R737.33[医药卫生—肿瘤]