术后化疗在早期子宫内膜癌治疗中的作用  

The role of postoperative adjuvant chemotherapy in early-stage endometrial cancer

作　　者：刘梦然[1] 温宏武[1] LIU Mengran;WEN Hongwu(Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China)

机构地区：[1]北京大学第一医院妇产科,100034

出　　处：《中国生育健康杂志》2020年第5期434-439,共6页Chinese Journal of Reproductive Health

摘　　要：目的探讨术后辅助化疗在有高危因素的早期子宫内膜癌患者中的治疗作用。方法收集2004年2月1日至2015年1月31日在北京大学第一医院行手术治疗、术后诊断为早期子宫内膜癌(FIGO 2009年分期I期及II期)且有随访结果的434例患者的临床资料,根据有无高危因素将患者分为高危组(169例,38.9%)和低危组(265例,61.1%),其中高危组112例、低危组21例行术后辅助化疗,分析辅助化疗与否及化疗疗程对患者预后的影响,对早期有高危因素的子宫内膜癌患者的生存影响因素进行单因素及多因素分析。结果高危化疗组和高危未化疗组5年生存率分别为95%、84%,化疗组高于未化疗组,差异有统计学意义;高危未化疗组和低危未化疗组5年生存率分别为84%、98%,高危未化疗组低于低危未化疗组,差异有统计学意义;高危化疗组和低危未化疗组5年生存率分别为95%、98%,两组之间无显著性差异。早期有高危因素、术后行辅助化疗的患者中,化疗疗程<4组与化疗疗程≥4组5年生存率分别为90%、98%,两组之间无显著性差异。多因素分析显示,术后化疗是早期高危子宫内膜癌患者生存的独立影响因素(HR=0.243,95%CI 0.061~0.971,P=0.045),术后化疗者生存时间更长。结论术后化疗可改善早期高危子宫内膜癌的预后,可以作为术后辅助治疗的手段之一。Objective To explore the role of postoperative adjuvant chemotherapy in early-stage endometrial cancer.MethodsWe retrospectively analyzed the clinical data of 434 patients who underwent operation and were diagnosed with early stage of endometrial cancer from Feb 1,2004 to Jan 31,2015 in Peking University First Hospital(the cases lost to follow-up were excluded).Cases withoneor more risk factors belonged to high-riskgroup(n=169,38.9%).Caseswithout any risk factor belonged to low-risk group(n=265,61.1%).There were 112 and 21 patients who underwent postoperative adjuvant chemotherapy inhigh-risk group and low-risk group,respectively.The effect of postoperativeadjuvantchemotherapy on prognosis was explored,along with therapy cycles.Univariate and multivariate analysis were performed to analyze the prognostic factors of early-stage endometrial cancer in high-risk group.Results In patients with early-stage endometrial cancer,there was statistical significance between 5-year survival rate with adjuvant chemotherapy(95%)and that without adjuvant chemotherapy(84%)in high-riskgroup(P=0.011).Five-year survival rate of high-risk group was lower than that of low-risk group for patients without adjuvant chemotherapy(84%versus 98%,P<0.001).Five-year survival rate of high-riskgroup with adjuvant chemotherapy and that of low-risk group without adjuvant chemotherapy were 95%and 98%,respectively(P=0.066).In high-risk group with adjuvant chemotherapy,5-year survival rate ofpatients who receivedlessthan 4 adjuvant chemotherapycycles and 4 or more adjuvant chemotherapy cycles were 90%and 98%,respectively(P=0.270).Multivariate analysis showed that postoperative adjuvant chemotherapy(HR=0.243,95%CI:0.061-0.971,P=0.045)was an independent influenced factor of survival time.Conclusions Postoperative chemotherapymay improve the prognosis of patients with high-risk early-stage endometrial cancer.It canbe used as one adjuvanttherapy for endometrial cancer.

关 键 词：子宫内膜癌 早期 高危因素 化疗 预后 

分 类 号：R73[医药卫生—肿瘤]