226例晚期子宫内膜癌的临床病理特征及治疗与其预后的相关因素分析

摘要

目的:分析晚期子宫内膜癌患者的临床病理特征、治疗情况及生存资料,探讨影响患者预后的独立因素.方法:收集并分析四川大学华西第二医院手术并经术后病理组织学证实为FIGOⅢ期及Ⅳ期子宫内膜癌患者226例的临床病理及生存资料,采用多因素Cox回归分析晚期子宫内膜癌预后[无进展生存(PFS)、总体生存(OS)]的相关因素.结果:中位OS时间为76月(95％CI 61.5 ～90.5),中位PFS时间为68月(95％CI 55.4～80.6).多因素分析结果显示,年龄≥54岁、低分化、非子宫内膜样癌、有淋巴脉管浸润、腹主动脉旁淋巴结转移阳性、腹水细胞学阳性、术后残留癌灶直径＞1 cm是影响PFS及(或)OS的独立危险因素(P＜0.05),而术后行不同的辅助治疗是PFS及(或)OS的保护因素(P＜0.05).结论:对于具有晚期子宫内膜癌预后的独立危险因素的患者,因其预后较差,术后放化疗有助于提高其生存率,应重视术后辅助治疗与随访监测.%Objective:To determine the clinicopathological characteristics and independent factors related to the survival of advanced endometrial cancer patients.Methods:We collected the data of clinical characteristics and followed up of 226 patients who were staged in Ⅲ-Ⅳ according to FIGO guideline in the West China Second Hospital of Sichuan University.Cox proportional hazards regression analyses were performed to identify independent predictors of prognosis.Results:The median overall survival (OS) time was 76 months (95％ CI 61.5-90.5).The median progression-free survival(PFS) time was 68 months(95％CI 55.4-80.6).The COX proportional hazards regression model identifed age ≥54 years old,poor differentiation,non-endometrioid carcinoma,lymphovascular space invasion,para-aortic lymph node positive,positive peritoneal cytology and postoperative residual tumor diameter ＞ 1 cm were independent risk factors of PFS and (or) OS (P ＜ 0.05).Post-operate adjuvant therapy was a protective factor of PFS and OS (P ＜ 0.05).Conclusions:Advanced endometrial cancer patients with these independent risk factors have a worse prognosis.As patients can benefit from post-operative combined radiotherapy and chemotherapy,we should pay more attention to post-operative adjuvant therapy and follow-up.