早期子宫内膜癌保留生育功能治疗后复发的诊治  

Diagnosis and management in patients with recurrent stage Ⅰ endometrial cancer after primary fertility-preserving treatment

作　　者：俞梅[1] 杨佳欣[1] 曹冬焱[1] 王遥[1] 沈铿[1] YU Mei, YANG Jiaxin, CAO Dongyan, WANG Yao, SHEN Keng(Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science ＆ Peking Union Medical College, Beijing 100730, Chin)

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：《山东大学学报（医学版）》2018年第5期23-29,共7页Journal of Shandong University:Health Sciences

基　　金：国家科技部十一五国家科技支撑计划(2008BAI57B02)

摘　　要：目的分析经保留生育功能治疗完全缓解(CR)后的早期子宫内膜癌(EC)患者,复发后再次治疗的效果及预后情况。方法回顾性分析2004年1月至2017年9月北京协和医院妇产科36例经高效孕激素或促性腺激素释放激素类似物(GnRH-a)治疗达到CR后复发患者的临床资料,其中25例行再次保留生育功能治疗,11例直接手术治疗,分析其疗效及预后。结果 36例患者中,复发后病理22例为EC,14例为不典型增生(AH)或子宫内膜上皮内瘤变(EIN)。患者在初次保守治疗结束后6~55个月复发,中位复发时间17个月。25例符合标准行再次保留生育功能治疗患者中,21例可评估疗效,其中16例达到CR(16/21,76.2%),显著低于初次治疗缓解率(93.6%)(P=0.016)。依照复发病理,AH/EIN患者CR率为90.9%(10/11),高于EC组的60.0%(6/10),但差异无统计学意义(P=0.149)。16例CR患者中,2例受孕并成功分娩,2例复发。5例保守治疗无效行手术治疗的患者中,术后分期ⅢA期2例,ⅠA期3例;3例术后需要辅助放疗+/-化疗,随诊均无复发。11例直接行手术治疗的患者中,8例于我院行手术治疗,术后分期为ⅢC2期1例、ⅠA期5例、EIN及AH1~2 2例,随诊无复发;3例失访。结论对于行保留生育功能治疗后复发的EC患者,再次保守治疗的有效率低于初次治疗的有效率,但仍可取得较好疗效,且患者有完成生育的可能。Objective To evaluate the efficacy and prognosis of secondary treatment on patients with recurrent endometrial cancer（EC） after complete remission（CR） for primary fertility-preserving therapy. Methods Thirty-six cases with recurrent EC after CR for primary fertility-preserving therapy from January 2004 to September 2017 at Peking Union M edical College Hospital were retrospectively analyzed. Twenty-five patients received the second course of fertility-preserving treatment and 11 patients received hysterectomy. The clinical efficacy and prognosis of the retreatment were also analyzed. Results Of the 36 recurrent patients with a median disease free interval period of 17 months（ranged 6 to 55 months）,22 were pathologically diagnosed as EC,and 14 were pathologically diagnosed as atypical hyperplasia（AH） or endometrial intraepithelial neoplasia（EIN）. Twenty-five patients met the criteria of fertility-preserving therapy and repeated hormonal therapy,and 21 patients were evaluable for efficacy,among whom,16 patients achieved CR（16/21,76.2%） with the lower CR rate than that of primary fertility-preserving treatment（93.6%）,P =0.016. According to the pathologic diagnosis of recurrence,the CR rate in AH/EIN patients was higher than that in EC patients while without a statistical difference（90. 9% vs 60. 0%,P = 0. 149）. Among 16 patients achieved CR,2 got pregnant and delivered successfully,while 2 relapsed again. Five cases failed to retreatment of fertility-preserving therapy then took the surgery; two of them were of stage ⅢA and three of stage ⅠA; three of them needed adjuvant radiotherapy ＋/-chemotherapy postoperatively,and no recurrence was observed during the follow-up. Eleven patients received surgery,eight of whom were treated in our hospital with one of stage ⅢC2,five of stage ⅠA,two diagnosed as EIN or AH1-2,and no recurrence was observed during the follow-up. Other three patients were lost to follow-up.Conclusion For patients with recurrent EC after primary fertility-pres

关 键 词：子宫内膜癌 子宫内膜不典型增生 子宫内膜上皮内瘤变 复发 保留生育功能治疗 

分 类 号：R711.74[医药卫生—妇产科学]