基础医学与临床 ›› 2017, Vol. 37 ›› Issue (4): 448-453.

• 子宫内膜癌专题 • 上一篇    下一篇

子宫内膜癌腹水细胞学阳性的危险因素和预后意义

宋晓1,金滢2,2,李艳2,单莹1,王永学1,尹婕3,曾靖1,韩甜甜1,潘凌亚4   

  1. 1. 北京协和医院
    2. 北京协和医院妇产科
    3. 中国医学科学院 北京协和医学院 北京协和医院
    4. 北京协和医院妇产科 北京
  • 收稿日期:2017-02-23 修回日期:2017-02-27 出版日期:2017-04-05 发布日期:2017-03-24
  • 通讯作者: 金滢 E-mail:jinypumc@aliyun.com

Prognostic Effect of Positive Peritoneal Cytology in Endometrial Cancer and Risk Factors for Positive Peritoneal Cytology

  • Received:2017-02-23 Revised:2017-02-27 Online:2017-04-05 Published:2017-03-24

摘要: 目的 探讨子宫内膜癌患者腹水细胞学阳性的危险因素和预后意义。方法 收集2005年1月1日至2010年12月31日北京协和医院收治的486例初治子宫内膜癌患者的临床资料进行回顾性分析,单因素及多因素分析腹水细胞学阳性对预后的影响。 结果 ①子宫内膜癌患者中腹水细胞学检查阳性率为4.8%。②非子宫内膜样癌(P=0.000)、FIGO分期(2009)为III-IV期(P=0.000)、子宫深肌层受累(P=0.001)、宫颈间质浸润(P=0.018)是子宫内膜癌腹水细胞学阳性的影响因素。③子宫内膜癌腹水细胞学阳性患者的5年无进展生存率(70.9% vs 90.0%) 、5年总生存率(72.2% vs 96.0%)均低于腹水细胞学阴性患者;单因素分析腹水细胞学阳性对无进展生存时间和总生存时间的影响,差异均具有统计学意义(P=0.005,P=0.000);④多因素分析显示腹水细胞学阳性并不是无进展生存时间、总生存时间的独立危险因素(RR=3.812,95%CI 0.897-16.200,P=0.070;RR=3.426,95%CI 0.800-14.673,P=0.097)。结论: 子宫内膜癌的腹水细胞学阳性,与非子宫内膜样的病理类型、FIGO分期(2009)、深肌层浸润、宫颈间质浸润相关。腹水细胞学阳性不是子宫内膜癌的独立预后影响因素。

关键词: 子宫内膜癌, 腹水细胞学, 预后

Abstract: Objective To determine the prognostic significance of positive peritoneal cytology (PPC) among patients with endometrial cancer and to find out risk factors for PPC in endometrial cancer. Methods Data were extracted from Peking Union Medical College Hospital between 2005 and 2010. Only those patients who had undergone a staging procedure were included. A total of 486 patients were identified. Statistical analyses used Fisher’s exact test, Kaplan–Meier log rank, and Cox proportional hazards models. Results Rate of PPC was 4.8% in endometrial cancer. Non-endometrioid endometrial cancer(P=0.000), stage III/IV(P=0.000), deep myometrial invasion(P=0.001), and cervical stromal involvement(P=0.018) appeared to be risk factors for PPC in endometrial cancer. Univariate analysis revealed statistically difference in 5yr-PFS (70.9% vs 90.0%) and 5yr-OS (72.2% vs 96.0%). Progression-free survival and overall survival showed statistically difference (P=0.005,P =0.000) between PPC and NPC endometrial cancer. On multivariate analysis, PPC remained no statistically difference in progression-free survival or overall survival(RR=3.812,95%CI 0.897-16.200,P=0.070;RR=3.426,95%CI 0.800-14.673,P=0.097). Conclusion PPC is not an independent risk factor in patients with endometrial cancer. Aggressive histology, FIGO stage, deep myometrial invasion, and cervical stromal involvement, are presumed to be associated with PPC in endometrial cancer.

Key words: Endometrial cancer, Peritoneal cytology, Prognosis

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