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目的分析子宫内膜浆液性乳头状癌的临床病理特点,探讨其治疗及预后。方法回顾性分析1996年1月—2005年12月在复旦大学附属肿瘤医院手术治疗的33例子宫内膜浆液性乳头状癌患者的临床病理资料。结果33例患者中,手术病理分期Ⅰ期11例,Ⅱ期2例,Ⅲ期7例,Ⅳ期13例。早期患者(Ⅰ期和Ⅱ期)13例,占39%;晚期患者(Ⅲ期和Ⅳ期)20例,占61%。Ⅰ、Ⅲ、Ⅳ期患者的3年总生存率分别为77·4%、53·3%、12·1%,3者间比较,差异有统计学意义(P=0·008)。对手术病理分期、淋巴结受累、肌层浸润深度、病理分级、脉管浸润和p53基因表达情况与预后的关系进行统计学分析,单因素分析发现,仅手术病理分期(P=0·008)和肌层浸润深度(P=0·025)与预后有关;多因素分析发现,仅手术病理分期和病理分级与预后有关(P均<0·05)。晚期患者中,行术后辅助化疗者的生存时间平均为30个月,明显长于未化疗者的6个月(P=0·014)。结论子宫内膜浆液性乳头状癌确诊时多为晚期,预后差。治疗强调全面的手术分期,术后辅助化疗可改善患者的预后。
Objective To analyze the clinicopathological features of endometrial serous papillary carcinoma and to discuss its treatment and prognosis. Methods The clinical data of 33 patients with endometrial serous papillary carcinoma who underwent surgical treatment from January 1996 to December 2005 in Cancer Hospital Affiliated to Fudan University were retrospectively analyzed. Results Among the 33 patients, 11 cases were stage Ⅰ, 2 cases were stage Ⅱ, 7 cases were stage Ⅲ and 13 cases were stage Ⅳ. Thirteen patients (39%) were in the early stage (stage I and stage II), and 20 cases (61%) in the advanced stage (stage III and stage IV). The 3-year overall survival rates of stage I, III and IV patients were 77.4%, 53.3% and 12.1%, respectively. The difference was statistically significant (P = 0.008). The pathological stage, lymph node involvement, depth of myometrial invasion, pathological grade, vascular invasion and the relationship between p53 gene expression and prognosis were analyzed statistically. Univariate analysis showed that only the pathological stage (P = 0.008) and The depth of myometrial invasion (P = 0 · 025) was related to the prognosis. Multivariate analysis showed that only the pathological stage and pathological grade of the operation were related to the prognosis (all P <0.05). Among patients with advanced disease, the average survival time of patients who received postoperative adjuvant chemotherapy was 30 months, significantly longer than that of those who did not undergo chemotherapy (P = 0.014). Conclusion Endometrial serous papillary carcinoma is mostly diagnosed late, the prognosis is poor. Treatment emphasizes a comprehensive surgical staging, postoperative adjuvant chemotherapy can improve the prognosis of patients.