结合免疫组化标志物和临床病理因素预测子宫内膜癌不同类型复发的预后生存  

Using Immunohistochemical Markers and Clinicopathological Factors to Predict the Prognostic Survival of Different Types of Endometrial Cancer Recurrence

作　　者：黄祯 蒋鹏[1] 贾明珠 李玲[1] 邓颖[1] 赖荔 胡琢瑛[1] HUANG Zhen;JIANG Peng;JIA Ming-zhu;LI Ling;DENG Ying;LAI Li;HU Zhuo-ying(Department of Gynecology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400000,China)

机构地区：[1]重庆医科大学附属第一医院妇科,重庆400000

出　　处：《四川大学学报（医学版）》2021年第3期489-496,共8页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨能够有效预测子宫内膜癌复发患者预后生存的影响因素。方法回顾性收集2013年10月-2019年5月共473例Ⅰ~Ⅲ期接受了标准手术治疗的子宫内膜癌患者的临床病理数据,术后随访患者复发情况。整体复发包括局部区域复发和不良预后复发。本研究的终点指标为整体复发、局部区域复发和不良预后复发患者的无复发生存(recurrence-free survival,RFS)和总生存(overall survival,OS)。使用Kaplan-Meier生存曲线评估患者OS和RFS。通过Cox回归分析寻找影响子宫内膜癌复发患者预后生存的因素。结果473例患者中,无复发患者406例,总共67例患者复发(14.2%),其中局部区域复发占27例(5.7%),不良预后复发占40例(8.5%),复发患者的中位随访时间为38个月。生存曲线示,无复发组患者RFS和OS不变,而复发组患者,无论是整体复发还是局部区域复发、不良预后复发,RFS和OS均下降(P<0.001);整体复发患者的3年OS率为44.8%,中位生存时间为29个月,中位复发时间为17个月;无复发组患者的3年OS率为98.8%,中位生存时间为40个月;局部区域复发患者3年OS率为59.3%,中位生存时间为27个月,中位复发时间为15个月;不良预后复发患者3年OS率仅为35.0%,中位生存时间为22个月,中位复发时间为10个月。多因素Cox回归分析结果显示,对于整体复发者而言,FIGO分期为Ⅲ期[风险比(HR)=3.432,P=0.005]、Ki-67的表达增高(HR=1.015,P=0.025)和ER的表达降低(HR=0.985,P=0.005)是RFS下降的独立因素,FIGO分期为Ⅲ期(HR=4.918,P=0.005)和PR的表达降低(HR=0.977,P=0.003)是OS下降的独立因素;对于局部区域复发者而言,特殊病理类型(HR=2.545,P=0.049)和Ki-67的表达增高(HR=1.024,P=0.033)是RFS下降的独立影响因素,PR的表达降低(HR=0.973,P=0.009)是OS下降的独立危险因素;对于不良预后复发者而言,FIGO分期Ⅲ期(HR=5.977,P=0.002)和ER表达降低(HR=0.984,P=0.023)是RFS下降的独立危险因素,FIGO分期Ⅲ期(HObjective To probe for factors that can be used effectively to predict the prognostic survival of patients with endometrial cancer recurrence.Methods The clinicopathological data of 473 patients with stageⅠtoⅢendometrial cancer who underwent standard surgical treatment from October 2013 to May 2019 were retrospectively collected,and post-operative recurrence of the patients were followed up.Overall recurrence includes local recurrence and poor prognosis recurrence.The endpoint indicators of this study are the recurrence-free survival(RFS)and overall survival(OS)of patients with overall recurrence,local recurrence,and poor prognosis recurrence(PPR).The KaplanMeier survival curve was used to evaluate the OS and RFS of patients.Cox proportional-hazards model was used to identify factors affecting the prognostic survival of patients with endometrial cancer recurrence.Results Among the 473 patients,406 did not experience recurrence.A total of 67 patients,accounting for 14.2%,had recurrence.Among them,27 had local recurrence,accounting for 5.7%,while 40 had poor prognosis recurrence,accounting for 8.5%.The median follow-up time of patients with recurrence was 38 months.The survival curve showed that the RFS and OS of the patients in the recurrence-free group remained unchanged,while the patients in the recurrence group,regardless of whether they had overall recurrence,local recurrence or PPR,experienced a decrease in RFS and OS(P<0.001).The overall 3-year OS rate of patients with recurrence was 44.8%,the median survival time was 29 months,and the median recurrence time was17 months.The 3-year OS rate of patients in the recurrence-free group was 98.8%,and the median survival time was 40 months;the 3-year OS rate of patients with local recurrence was 59.3%,the median survival time was 27 months,and the median recurrence time was 15 months.The 3-year OS rate of patients with PPR was only 35.0%,the median survival time was 22 months,and the median recurrence time was 10 months.The results of multivariate Cox regression

关 键 词：子宫内膜癌 免疫组化指标 临床病理因素 不良复发 

分 类 号：R737.33[医药卫生—肿瘤]