低级别子宫内膜样腺癌预后影响因素及其与MELF浸润的关系  

Prognostic factors and relationship with MELF invasion in endometrioid adenocarcinoma patients with low grade

作　　者：黄相艳[1] 王富强[2] 段情 王苗苗 李秀芳[1] HUANG Xiangyan;WANG Fuqiang;DUAN Qing;WANG Miaomiao;LI Xiufang(Department of Gynecological Oncology,Anyang Cancer Hospital,Henan Anyang 455000,China;Pathology Center,Anyang Cancer Hospital,Henan Anyang 455000,China)

机构地区：[1]安阳市肿瘤医院妇瘤科,河南安阳455000 [2]安阳市肿瘤医院病理中心,河南安阳455000

出　　处：《现代肿瘤医学》2023年第19期3630-3634,共5页Journal of Modern Oncology

摘　　要：目的:探讨病理分级1-2级子宫内膜样腺癌预后影响因素及与微囊性/伸长/碎片状(microcystic,elongated,and fragmented,MELF)浸润的关系,为临床治疗方案制定及预后评估提供更多证据。方法:回顾性纳入2010年01月至2017年06月于我院诊治病理分级1-2级子宫内膜样腺癌患者共266例,由高年资病理医生重新阅片,根据是否存在MELF浸润分为MELF组(40例)和非MELF组(226例),比较两组临床病理特征资料及随访生存资料,采用多因素法评估盆腔淋巴结转移风险和5年无进展生存独立影响因素,并进一步评估MELF浸润对患者临床预后的影响及预测价值。结果:MELF组CA125水平、子宫颈间质侵犯比例、子宫肌层侵犯达1/2以上比例、盆腔淋巴结转移比例及脉管癌栓比例均显著高于非MELF组(P<0.05)。整体人群MELF组5年无进展生存率显著低于非MELF组(P<0.05);FIGOⅠ期和FIGOⅡ期患者中非MELF组5年无进展生存率高于MELF组(P<0.05);FIGOⅢ期患者中MELF组和非MELF组5年无进展生存率比较差异无统计学意义(P>0.05)。Logistic回归模型多因素分析结果显示,MELF浸润是盆腔淋巴结转移独立危险因素(P<0.05);Cox比例风险回归模型多因素分析结果显示,MELF浸润与脉管癌栓均是无进展生存独立危险因素(P<0.05);ROC曲线分析结果显示,MELF浸润用于盆腔淋巴结转移及疾病进展风险预测具有良好效能,AUC分别为0.82(95%CI:0.70~0.90)、0.84(95%CI:0.74~0.96)。结论:MELF浸润与CA125水平、子宫颈间质侵犯、子宫肌层侵犯程度、盆腔淋巴结转移及脉管癌栓有一定相关性;MELF浸润的子宫内膜样腺癌患者存在更高盆腔淋巴结转移及疾病进展风险。Objective:To investigate the prognostic factors and relationship with microcystic,elongated,and fragmented(MELF)invasion in endometrioid adenocarcinoma patients with grade 1-2,to provide more evidence for clinical treatment planning and prognostic evaluation.Methods:266 endometrioid adenocarcinoma patients with grade 1-2 were retrospectively chosen in the period from January 2010 to June 2017.All patients were grouped according to presence or absence of MELF infiltration and included MELF group(40 cases)and non-MELF group(226 cases).The clinicopathological characteristics and follow-up survival data were compared between 2 groups.The risk of pelvic lymph node metastasis and independent influencing factors of 5-year progression-free survival were evaluated by multivariate analysis method,and the influence and predictive value of MELF infiltration on clinical prognosis were further evaluated. Results: The level of CA125, the proportion of cervical interstitial invasion,the proportion of myometrium invasion more than half,the proportion of pelvic lymph node metastasis and the proportion of vascular tumor thrombus in MELF group were significantly higher than non-MELF group( P <0.05).The 5-year progression-free survival of MELF group was significantly lower than non-MELF group in overall population( P <0.05).The 5-year progression-free survival of non-MELF group was significantly higher than MELF group in FIGO stage Ⅰ and Ⅱ population( P <0.05).There was no significant difference in 5-year progression-free survival between MELF group and non-MELF group in FIGO stage Ⅲ population( P >0.05).Multivariate analysis of Logistic regression model showed that MELF infiltration was the independent risk factor of pelvic lymph node metastasis( P <0.05).Multivariate analysis of Cox proportional hazards regression model showed that MELF infiltration and vascular tumor thrombus were the independent risk factors of progression-free survival( P <0.05).ROC curve analysis showed that MELF infiltration had satisfactory efficacy in

关 键 词：子宫内膜样腺癌 预后 微囊性/伸长/碎片状浸润 淋巴结转移 无进展生存 

分 类 号：R737.33[医药卫生—肿瘤]