子宫内膜癌腹水细胞学阳性的危险因素和预后意义  

Risk factors and prognostic significance of positive peritoneal cytology in endometrial cancer

作　　者：宋晓[1] 金滢[1] 李艳[1] 单莹[1] 王永学[1] 尹婕[1] 曾靖[1] 韩甜甜[1] 潘凌亚[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,北京100730

出　　处：《基础医学与临床》2017年第4期448-453,共6页Basic and Clinical Medicine

摘　　要：目的探讨子宫内膜癌患者腹水细胞学阳性的危险因素和预后意义。方法收集2005年1月1日至2010年12月31日北京协和医院收治的486例初治子宫内膜癌患者的临床资料进行回顾性分析,单因素及多因素分析腹水细胞学阳性对预后的影响。结果 1)子宫内膜癌患者中腹水细胞学检查阳性率为4.8%。2)非子宫内膜样癌(P=0.000)、FIGO分期(2009)为Ⅲ-Ⅳ期(P=0.000)、子宫深肌层受累(P=0.001)、宫颈间质浸润(P=0.018)是子宫内膜癌腹水细胞学阳性的影响因素。3)子宫内膜癌腹水细胞学阳性患者的5年无进展生存率(70.9%vs90.0%)、5年总生存率(72.2%vs 96.0%)均低于腹水细胞学阴性患者;单因素分析腹水细胞学阳性对无进展生存时间和总生存时间的影响,差异均具有统计学意义(P=0.005,P=0.000);4)多因素分析显示腹水细胞学阳性并不是无进展生存时间、总生存时间的独立危险因素(RR=3.812,95%CI 0.897~16.200,P=0.070;RR=3.426,95%CI 0.800~14.673,P=0.097)。结论子宫内膜癌的腹水细胞学阳性与非子宫内膜样的病理类型、FIGO分期(2009)、深肌层浸润、宫颈间质浸润相关。腹水细胞学阳性不是子宫内膜癌的独立预后影响因素。Objective To determine the prognostic significance of positive peritoneal cytology（ PPC） among patients with endometrial cancer and to find out potential risk factors for PPC in endometrial cancer. Methods Data were extracted from Peking Union Medical College Hospital between Jan 1 2005 and Dec 31 2010. Only those patients who had undergone a staging procedure were included. A total of 486 patients were identified. Statistical analyses were performed using Fisher＇s exact test,Kaplan-Meier log rank,and Cox proportional hazards models. Results Rate of PPC was 4. 8% in endometrial cancer. Non-endometrioid endometrial cancer（ P = 0. 000）,stage Ⅲ/Ⅳ（ P = 0. 000）,deep myometrial invasion（ P = 0. 001）,and cervical stromal involvement（ P = 0. 018） appeared to be risk factors for PPC in endometrial cancer. Univariate analysis revealed statistically difference in 5-year PFS（ 70. 9% vs 90. 0%） and 5-year OS（ 72. 2% vs 96. 0%）. Progression-free survival and overall survival showedstatistically difference（ P = 0. 005,P = 0. 000） between PPC and NPC endometrial cancer. On multivariate analysis,PPC remained no statistically difference in progression-free survival or overall survival（ RR = 3. 812,95% CI 0. 897-16. 200,P = 0. 070; RR = 3. 426,95% CI 0. 800-14. 673,P = 0. 097）. Conclusions PPC is not an independent risk factor in patients with endometrial cancer. Aggressive histology,FIGO stage,deep myometrial invasion and cervical stromal involvement are presumed to be associated with PPC in endometrial cancer.

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]