腹水细胞学阳性在子宫内膜癌患者随访中的生存意义  

Survival significance of positive peritoneal cytology in follow-up of patients with endometrial cancer

作　　者：安民 张玉虹[1] 赵雅璇 陈江平[1] An Min;Zhang Yuhong;Zhao Yaxuan(Department of Gynecology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000)

机构地区：[1]河北北方学院附属第一医院妇科,张家口075000

出　　处：《现代妇产科进展》2022年第12期881-884,共4页Progress in Obstetrics and Gynecology

基　　金：河北省科技厅(No:182777232)。

摘　　要：目的:探讨腹水细胞学阳性对子宫内膜癌患者预后的价值。方法:基于2010年1月1日至2015年12月31日SEER数据库收录的子宫内膜癌患者的临床资料,采用单因素和多因素分析,按年龄、手术分期、组织学类型、病理分级和肿瘤大小评估腹水细胞学阳性对子宫内膜癌预后的意义。结果:总体研究人群中,子宫内膜癌患者腹水细胞学阳性率为9.3%。在不同年龄组中,这一比率相似。I期、Ⅱ期、Ⅲ期和Ⅳ期子宫内膜癌腹水细胞学阳性率分别为4.5%、8.9%、25.8%和63.7%。子宫内膜样腺癌、透明/浆液性癌和苗勒氏混合瘤的腹水细胞学阳性率分别为7.3%、30.0%和25.7%。G1级、G2级、G3级子宫内膜癌的腹水细胞学阳性率分别为4.5%、8.8%和20.9%。肿瘤直径<2cm、2~5cm和>5cm子宫内膜癌患者的腹水细胞学阳性率分别为5.4%、8.6%和15.5%。在预后方面,年龄大、特殊组织学类型、病理分级高、手术分期晚、肿瘤直径大与生存时间短有关。多变量Cox模型中控制这些因素后,腹水细胞学阳性仍与总生存率较低相关(HR=1.418,P<0.001)。结论:腹水细胞学阳性是子宫内膜癌患者的独立预后因素。妇科肿瘤医生应重视腹水细胞学检查结果,并将腹水细胞学阳性作为随访的危险因素。Objective:To explore the prognostic value of positive peritoneal cytology(PPC)for patients with endometrial cancer(EC).Method:Based on the clinical data of endometrial cancer patients included in SEER database from January 1,2010 to December 31,2015,the significance of positive peritoneal cytology on the prognosis of endometrial cancer was evaluated by using univariate and multivariate analysis according to age,surgical stage,histological type,pathological grade,and tumor size.Results:The positive rate of peritoneal cytology was 9.3% in the whole group of patients with endometrial cancer.The rates were similar in different age groups.The rates were 4.5% in stage Ⅰ,8.9% in stage Ⅱ,25.8%in stage Ⅲ and 63.7%in stage Ⅳ.The rates were 7.3% in endometrioid adenocarcinoma,30.0% in clear/serous carcinoma and 25.7%in mullerian mixed tumor.The rates were 4.5% in grade 1 tumor,8.8% in grade 2 tumor and 20.9% in grade 3 tumor.The rates were 5.4%,8.6% and 15.5% in patients with tumor diameter<2 cm,2~5 cm and over 5 cm,respectively.In terms of prognosis,older age,special histological type,high grade,late stage and large tumor diameter were associated with shorter survival time.After controlling for these factors in a multivariable Cox model,PPC was still associated with inferior overall survival(HR=1.418,P<0.001).Conclusion:PPC is an independent prognostic factor in EC patients.Gynecological oncologists should pay more attention to the results of peritoneal cytology and take PPC as a risk factor in the follow-up.

关 键 词：子宫内膜癌 腹水细胞学 随访 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]