腹腔冲洗液细胞学检查结果对子宫内膜浆液性癌患者预后的影响  

The impact of peritoneal cytology test results on the prognosis of patients with uterine serous carcinoma

作　　者：朱雨涵 于靖蓉 杨欣 佐晶 程敏 张功逸 姚洪文 袁光文 李楠 郭会芹 李宁 Zhu Yuhan;Yu Jingrong;Yang Xin;Zuo Jing;Cheng Min;Zhang Gongyi;Yao Hongwen;Yuan Guangwen;Li Nan;Guo Huiqin;Li Ning(Department of Gynecologic Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Pathology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院妇科,北京100021 [2]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院病理科,北京100021

出　　处：《中华医学杂志》2025年第8期598-604,共7页National Medical Journal of China

摘　　要：目的探讨腹腔冲洗液细胞学(PC)检查结果对子宫内膜浆液性癌(USC)患者预后的影响。方法回顾性收集2004—2020年中国医学科学院肿瘤医院收治的USC患者,收集其既往是否行输卵管结扎、术前宫腔镜史、病理、手术及辅助治疗方式等病历信息,复阅PC切片,腹腔冲洗液细胞学阳性(PPC)者为PPC组,腹腔冲洗液细胞学阴性(NPC)者为NPC组。采用Kaplan-Meier方法对USC患者进行生存分析,多因素Cox比例风险回归模型分析USC患者预后相关因素。结果共纳入147例USC患者,年龄[M(Q1,Q3)]为60(54,64)岁,PPC组43例(29.3%),NPC组104例(70.7%)。随访时间[M(Q1,Q3)]为60(34,73)个月,52例USC复发,30例死亡,5年累积无进展生存率为66.5%,5年累积总生存率为79.2%。PPC组的5年累积无进展生存率(41.2%比77.0%)和5年累积总生存率(58.6%比87.1%)均低于NPC组(均P<0.001)。在无盆腹腔转移的102例USC患者(Ⅰ期、Ⅱ期及单纯淋巴结转移的Ⅲ期患者)中,PPC是USC复发(HR=4.191,95%CI:1.729~10.165)和患者死亡(HR=4.306,95%CI:1.351~13.731)的相关因素。在有盆腹腔转移的45例患者中,PPC不是USC复发(HR=1.450,95%CI:0.637~3.303)和患者死亡(HR=1.520,95%CI:0.488~4.730)的相关因素。结论在USC患者中,PPC患者较NPC患者预后更差。PPC是无盆腹腔转移USC患者的预后相关因素。Objective To explore the impact of peritoneal cytology(PC)test results on prognosis in patients with uterine serous carcinoma(USC).Methods Medical record information including history of tubal ligation and preoperative hysteroscopy,pathology,surgery,adjuvant therapy,etc.of USC patients admitted to the Cancer Hospital,Chinese Academy of Medical Sciences from January 2004 to December 2020 was retrospectively collected and the cytological sections of PC were reviewed.Positive peritoneal cytology(PPC)patients were classified as PPC group while negative peritoneal cytology(NPC)patients were NPC group.The survival analyses were performed by Kaplan Meier method and prognostic factors of USC patients were analyzed by Cox proportional hazards regression model.Results A total of 147 USC patients were included,aged[M(Q 1,Q 3)]60(54,64)years.There were 43 cases(29.3%)in the PPC group and 104 cases(70.7%)in the NPC group.The follow-up time was[M(Q 1,Q 3)]60(34,73)months,with 52 cases of USC recurrence and 30 patients deaths.The 5-year progression free survival rate was 66.5%and the 5-year overall survival rate was 79.2%.Both 5-year progression free survival rate(41.2%vs 77.0%)and 5-year overall survival rate(58.6%vs 87.1%)were lower in PPC group than those in NPC group(both P<0.001).In 102 patients without pelvic abdominal involvement(stageⅠ,Ⅱ,and stageⅢpatients with only lymph node metastasis),PPC was associated with USC recurrence(HR=4.191,95%CI:1.729-10.165)and USC patients death(HR=4.306,95%CI:1.351-13.731).Among 45 patients with pelvic abdominal involvement,PPC was not associated with USC recurrence(HR=1.450,95%CI:0.637-3.303)or patient death(HR=1.520,95%CI:0.488-4.730).Conclusions In USC patients,compared with NPC,PPC patients have poorer prognosis.PPC is a factor for prognosis in USC patients without pelvic abdominal involvement.

关 键 词：子宫内膜肿瘤 子宫内膜浆液性癌 腹腔冲洗液细胞学 预后 

分 类 号：R737.33[医药卫生—肿瘤]