22例子宫内膜癌复发病例的临床特点分析

摘要

目的 总结子宫内膜癌复发的临床特点.方法 2006年1月～2015年12月,我院首次确诊为子宫内膜癌,临床资料完整,经病理学诊断确诊为子宫内膜癌,前次手术为标准的系统分期手术,接受再次手术或穿刺病理证实为子宫内膜癌复发,并进行随访的患者共22例,对临床资料进行回顾性分析.结果 22例首次确诊内膜癌的中位年龄为52岁(44～63岁),绝经后阴道出血为子宫内膜癌最常见的临床症状(54.5％,12/22).子宫内膜样腺癌18例(81.8％),浆液性腺癌3例(13.6％),透明细胞癌1例(4.5％).子宫肌层受累情况:局限于黏膜内0例,肌层浸润＜ 1/2 14例(63.6％),肌层浸润＞ 1/2 7例(31.8％),肌层浸润达浆膜层1例(4.5％),穿透浆膜层0例;淋巴结阳性4例(18.2％),均为盆腔淋巴结,腹主动脉旁淋巴结均阴性.术后病理分期FIGO Ⅰ A期12例(54.5％),ⅠB期5例(22.7％),Ⅱ期1例(4.5％),ⅢC1期4例(18.2％).中位肿瘤复发时间4年(1.5 ～7年),均无明显自觉症状,血清CA125升高12例(54.5％),超声或CT发现局部肿块9例(40.9％),体检胸部X线片发现肺占位1例(4.5％).盆腔内复发14例(63.6％),腹膜后髂血管周围淋巴结复发6例(27.3％),前腹壁腹膜外转移合并肺转移复发1例(4.5％),肺转移复发1例(4.5％).3例接受Lynch综合征筛查,其中2例阳性.结论 子宫内膜癌复发病例中,肿瘤肌层浸润较常见,复发患者临床症状不明显,盆腔内复发为最常见的复发部位.%Objective To summarize the clinical characteristics of recurrent endometrial carcinoma.Methods A total of 22 cases of recurrent endometrial carcinoma from January 2006 to December 2015 were enrolled.Primary diagnosis of endometrial carcinoma were made in our hospital,with complete clinical data and standard NCCN staging operation.The recurrence of endometrial cancer was confirmed by pathological diagnosis after second surgery or biopsy.Clinical data were retrospectively analyzed.Results The median age of primary diagnosis was 52 years old (rang,44-63 years old).And the most common clinical symptom was postmenopausal vaginal bleeding (54.5％,12/22).There were 18 cases (81.8％) of endometrial adenocarcinoma,3 cases (13.6％) of serous adenocarcinoma,and 1 case (4.5％) of clear cell carcinoma.As to the muscular layer infiltration,there were 14 cases (63.6％) ＜ 1/2,7 cases (31.8％) ＞ 1/2 and 1 case (4.5％) involving the whole layer.There were 4 cases (18.2％) of positive pelvic lymph node and no para-aortic lymph nodes metastasis.As to the postoperative clinical pathologic stage,there were 12 cases (54.5％) of FIGO Ⅰ A,5 cases (22.7％) of FIGO Ⅰ B,1 case (4.5％) of FIGO Ⅱ,and4 cases (18.2％) of FIGO ⅢC1.The median recurrent time was 4 years (rang,1.5-7 years),without obvious self-conscious symptoms,including serum CA125 elevated in 12 cases (54.5％) and positive ultrasound,CT or X-ray examination findings in 10 cases (45.5％).As to the recurrence location,14 cases (63.6％) were in the pelvic cavity,6 cases (27.3％) of retroperitoneal lymph nodes,1 case (4.5％) of anterior abdominal wall accompaning lung metastasis,and 1 case (4.5％) of lung metastasis.Three patients accept Lynch syndrome screening,of which 2 cases were positive.Conclusions Muscular layer infiltration is common in recurrence of endometrial cancer,with no obvious clinical symptoms.Pelvic cavity is the most common location of recurrence.