Ⅰ型子宫内膜癌的预后危险因素分析

摘要/Abstract

摘要：

目的研究影响Ⅰ型子宫内膜癌患者预后的危险因素。方法选取西南医科大学第一附属医院2010年1月至2015年1月收治的279例Ⅰ型子宫内膜癌患者作为研究对象,回顾性分析所有患者的临床资料。采用Kaplan-Meier法估计患者的生存率,采用Cox回归风险模型分析可能影响子宫内膜癌患者预后的危险因素。结果279例子宫内膜癌患者术后复发36例,5年无瘤生存率为87.10%(243/279)。患者2、3、5年生存率分别为95.9%(95%CI为93.6%~98.3%)、94.3%(95%CI为91.6%~97.2%)、90.4%(95%CI为86.6%~94.3%)。单因素分析显示,肥胖(HR=2.194,95%CI为1.031~4.671,P=0.041)、肌层浸润深度(HR=2.957,95%CI为1.382~6.329,P=0.005)、组织学分级(G2:HR=3.271,95%CI为1.336~8.010,P=0.010;G3:HR=9.933,95%CI为3.565~27.672,P<0.001)、肿瘤大小(HR=8.067,95%CI为2.426~26.821,P=0.001)、腹腔细胞学(HR=3.293,95%CI为1.523~7.121,P=0.002)、手术-病理分期(Ⅲ期:HR=28.357,95%CI为11.516~69.828,P<0.001)、淋巴结性质(HR=14.629,95%CI为5.023~42.606,P<0.001)、宫颈间质浸润(HR=3.806,95%CI为1.653~8.764,P=0.002)、附件转移(HR=9.101,95%CI为3.831~21.622,P<0.001)、淋巴血管间隙浸润(HR=5.011,95%CI为2.233~11.249,P<0.001)均与患者预后相关;多因素分析显示,肌层浸润深度(HR=2.503,95%CI为1.115~5.616,P=0.026)、组织学分级(G2:HR=3.143,95%CI为1.205~8.198,P=0.019;G3:HR=3.655,95%CI为1.151~11.610,P=0.028)、手术-病理分期(Ⅲ期:HR=27.701, 95%CI为9.608~79.869,P<0.001)及淋巴血管间隙浸润(HR=3.297,95%CI为1.370~7.936,P=0.008)均是子宫内膜癌患者预后的独立危险因素。结论肥胖、肌层浸润深度、组织学分级、肿瘤大小、腹腔细胞学、手术-病理分期、淋巴结性质、宫颈间质浸润、附件转移、淋巴血管间隙浸润均对患者预后产生影响,其中肌层浸润深度、组织学分级、手术-病理分期及淋巴血管间隙浸润均是Ⅰ型子宫内膜癌患者预后的独立危险因素。

关键词:子宫内膜肿瘤,预后,淋巴血管间隙浸润,肌层浸润深度

Abstract:

ObjectiveTo study the risk factors affecting the prognosis of patients with type Ⅰ endometrial cancer.MethodsA total of 279 patients with type Ⅰ endometrial cancer admitted to the First Affiliated Hospital of Southwest Medical University were enrolled from January 2010 to January 2015. The clinical data of all patients were retrospectively analyzed. The Kaplan-Meier method was used to estimate patients' survival rate. Cox regression risk model was used to analyze the risk factors that might affect the prognosis of patients with endometrial cancer.ResultsOf 279 patients with endometrial cancer, postoperative recurrence was observed in 36 patients. The 5-year disease free survival rate was 87.10%(243/279). The 2, 3 and 5-year survival rates were 95.9% (95%CI: 93.6%-98.3%), 94.3%(95%CI: 91.6%-97.2%), and 90.4% (95%CI: 86.6%-94.3%). Univariate analysis showed that obesity (HR=2.194, 95%CI: 1.031-4.671,P=0.041), myometrial invasion (HR=2.957, 95%CI: 1.382-6.329,P=0.005), tissue grading (G2:HR=3.271, 95%CI: 1.336-8.010,P=0.010; G3:HR=9.933, 95%CI: 3.565-27.672,P<0.001), tumor size (HR=8.067, 95%CI: 2.426-26.821,P=0.001), abdominal cytology (HR=3.293, 95%CI: 1.523-7.121,P=0.002), surgery-pathological staging (Ⅲ stage:HR=28.357, 95%CI: 11.516-69.828,P<0.001), nature of lymph node (HR=14.629, 95%CI: 5.023-42.606,P<0.001), cervical interstitial infiltration (HR=3.806, 95%CI: 1.653-8.764,P=0.002), accessory metastasis (HR=9.101, 95%CI: 3.831-21.622,P<0.001) and lymphovascular space invasion (HR=5.011, 95%CI: 2.233-11.249,P<0.001) were all correlated with the prognosis of the patients. Multivariate analysis showed that the independent risk factors for the prognosis of endometrial cancer patients were depth of myometrial invasion (HR=2.503, 95%CI: 1.115-5.616,P=0.026), histological grading (G2:HR=3.143, 95%CI: 1.205-8.198,P=0.019; G3:HR=3.655, 95%CI: 1.151-11.610,P=0.028), surgery-pathological staging (Ⅲ stage:HR=27.701, 95%CI: 9.608-79.869,P<0.001) and lymphovascular space invasion (HR=3.297, 95%CI: 1.370-7.936,P=0.008).ConclusionObesity, myometrial invasion, tissue grading, tumor size, abdominal cytology, surgery-pathological staging, nature of lymph node, cervical interstitial infiltration, adnexal metastasis and lymphovascular space invasion all affect the prognosis of patients. Depth of myometrial invasion, histological grading, surgical-pathological staging and lymphovascular space invasion are independent risk factors for the prognosis of patients with Ⅰ endometrial cancer.

Key words:Endometrial neoplasms,Prognosis,Lymphovascular space invasion,Myometrial invasion

周露秋, 刘先喜, 李艳, 毛熙光. Ⅰ型子宫内膜癌的预后危险因素分析[J]. 国际肿瘤学杂志, 2020, 47(6): 346-350.

Zhou Luqiu, Liu Xianxi, Li Yan, Mao Xiguang. Analysis of prognostic risk factors of type Ⅰ endometrial cancer[J]. Journal of International Oncology, 2020, 47(6): 346-350.

图/表4

表1

279例子宫内膜癌患者的一般临床资料"

临床特征	例数(%)	临床特征	例数(%)
年龄(岁)		肥胖
<50	120(43.0)	是	89(31.9)
≥50	159(57.0)	否	190(68.1)
高血压		糖尿病
有	72(25.8)	有	76(27.2)
无	207(74.2)	无	203(72.8)
组织学分级		手术-病理分期
G1	166(59.5)	Ⅰ	218(78.1)
G2	88(31.5)	Ⅱ	23(8.2)
G3	25(9.0)	Ⅲ	38(13.6)
肿瘤大小(cm)		腹腔细胞学
≥2	151(54.1)	阳性	60(21.5)
<2	128(45.9)	阴性	219(78.5)
淋巴结切除		淋巴结性质^a
是	227(81.4)	阳性	11(4.8)
否	52(18.6)	阴性	216(95.2)
宫颈间质浸润		附件转移
是	36(12.9)	是	28(10.0)
否	243(87.1)	否	251(90.0)
淋巴血管间隙浸润		肌层浸润深度
是	32(11.5)	≥1/2	67(24.0)
否	247(88.5)	<1/2	212(76.0)

表1

图1

表2

279例子宫内膜癌患者预后影响因素的单因素分析"

变量	HR值	95%CI	P值
年龄	2.096	0.916~4.796	0.080
高血压	1.797	0.822~3.936	0.142
肥胖	2.194	1.031~4.671	0.041
糖尿病	1.896	0.879~4.088	0.103
肌层浸润深度	2.957	1.382~6.329	0.005
组织学分级
G1	1	-	-
G2	3.271	1.336~8.010	0.010
G3	9.933	3.565~27.672	<0.001
肿瘤大小	8.067	2.426~26.821	0.001
腹腔细胞学	3.293	1.523~7.121	0.002
手术-病理分期
Ⅰ	1	-	-
Ⅱ	2.693	0.589~12.317	0.202
Ⅲ	28.357	11.516~69.828	<0.001
淋巴结切除	6.900	0.936~50.857	0.058
淋巴结性质^a	14.629	5.023~42.606	<0.001
宫颈间质浸润	3.806	1.653~8.764	0.002
附件转移	9.101	3.831~21.622	<0.001
淋巴血管间隙浸润	5.011	2.233~11.249	<0.001
术后辅助治疗	0.828	0.635~1.079	0.163
手术方式	1.142	0.844~1.545	0.389

表2

表3

227例子宫内膜癌患者预后影响因素的多因素分析"

变量	HR值	95%CI	P值
肥胖	0.510	0.216~1.206	0.125
肌层浸润深度	2.503	1.115~5.616	0.026
组织学分级(G1)	1	-	-
组织学分级(G2)	3.143	1.205~8.198	0.019
组织学分级(G3)	3.655	1.151~11.610	0.028
肿瘤大小	0.399	0.103~1.555	1.860
腹腔细胞学	1.298	0.510~3.306	0.584
手术-病理分期(Ⅰ期)	1	-	-
手术-病理分期(Ⅱ期)	1.368	0.277~6.755	0.701
手术-病理分期(Ⅲ期)	27.701	9.608~79.869	<0.001
淋巴结性质	1.169	0.292~4.677	0.825
宫颈间质浸润	1.436	0.335~26.709	0.626
附件转移	5.065	0.961~26.709	0.056
淋巴血管间隙浸润	3.297	1.370~7.936	0.008

表3

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