遗传性非息肉性结直肠癌综合征相关性子宫内膜癌的临床病理特征

摘要

目的 探讨遗传性非息肉性结直肠癌综合征(HNPCC)相关性子宫内膜癌的临床病理特征.方法 采用回顾性分析方法,将1981年1月至2006年6月间天津医科大学总医院421例住院的子宫内膜癌患者根据有无恶性肿瘤家族史分为3组:A组:散发性子宫内膜癌,331例;B组:非特异肿瘤聚集性子宫内膜癌,63例;C组:HNPCC相关性子宫内膜癌,27例.比较3组临床病理特征的差异.结果 HNPCC相关性子宫内膜癌占全部子宫内膜癌患者的6.4%(27/421);平均发病年龄为49.7岁,明显早于A组的56.3岁及B组的55.2岁,C组分别与A组、B组比较,差异均有统计学意义(P=0.004、0.035).C组患者合并其他部位原发肿瘤的发生率为33.3%(9/27),较A组及B组的5.1%(17/331)及14.3%(9/63)显著升高;C组分别与A组、B组比较,差异均有统计学意义(P值分别为＜0.01、0.038).3组患者绝经状态及病理类型无显著差异(P均＞0.05).C组及B组病理分级G1患者分别为70.4%(19/27)、61.3%(38/62),明显高于A组的45.5%(141/310);C组及B组分别与A组比较,差异均有统计学意义(JP值分别为0.013、0.023).C组患者的预后明显好于A组,病死率低于A组,两组比较,差异有统计学意义(x2=5.337,P=0.021).C组患者的5年和10年生存率均为96%,B组分别为88%、85%,A组分别为80%、70%.结论 HNPCC相关性较散发性子宫内膜癌平均发病年龄早,易合并其他部位原发肿瘤,以高分化癌多见,预后较好.%Objective To study clinicopathological characteristics of hereditary nonpolyposis colorectal carcinoma(HNPCC)-associated endometrial carcinoma(EC).Methods Totally 421 EC patients admitted to General Hospital of Tianjin Medical University from 1981 to 2006 were divided into three groups:group A:sporadic EC;group B:familial aggregation of EC;group C:HNPCC-associated EC.Results HNPCC-associated EC accounted for 6.4%(27/421).Mean age at time of diagnosis was 49.7years in group C,earlier than 56.3 years in group A(P=0.004)and 55.2 years in group B(P=0.035).There were 33.3%(9/27)patients with multiple primary carcinomas in group C.It was higher than 14.3%(9/63)in group B and 5.1%(17/331)in group A respectively(P=0.038,P＜0.01).There was no difference among the three groups in histological type or menopausal status(P＞0.05).The numbers of patients with low grade EC in group C(70.4%,19/27)and group B(61.3%,38/62)were more than that in Group A(P=0.013,P=0.023).Prognosis for group C was better than that in group A(P=0.021),and 5-and 10-year survival rate in groups A,B and C was 80%,70%;88%,85%;and 96%,96%respectively.Conclusions Mean age at time of diagnosis is earlier in HNPCC-associated EC than that in sporadic EC;patients with HNPCC-associated EC are more frequently complicated with multiple primary carcinomas and of low grade;prognosis is better.