Li Bin, Wu Ling-Ying, Li Shu-Min, Zhang Wen-Hua, Zhang Rong, Ma Shao-Kang
Department of Gynecologic Oncology, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100021, PR China.
Ai Zheng. 2004 Sep;23(9):1085-8.
BACKGROUND & OBJECTIVE: A number of prognostic factors have been evaluated in endometrial carcinoma. Among them, only a few factors have been recognized as major adverse factors affecting prognosis independently. This study was to explore the independent prognostic factors in endometrial carcinoma.
A total of 265 patients who accepted primary surgical treatment in our hospital from Jan. 1990 to Dec. 2000 were studied retrospectively. Prognostic factors were analyzed using univariate model and multivariate regression model.
The 5-year recurrence-free survival rate of all patients was 83.3%, and 5-year overall survival rate was 84.3%. The univariate model revealed that clinical stage, pathological stage, pathologic grade, pathologic subtype, depth of muscularis invasion, cervical invasion, lymph node metastasis, peritoneal cytology, lymph-vascular invasion, and adnexa metastasis significantly associated with 5-year recurrence-free survival, and 5-year overall survival (P< 0.05), while age, and complications have no significant association with prognosis (P >0.05). However,on multivariate regression analysis, only pathohistological stage, pathologic grade, depth of muscularis invasion, and cervical invasion significantly correlated with 5-year recurrence-free survival, and 5-year overall survival (P< 0.05); clinical stage correlated with 5-year recurrence-free survival significantly (P< 0.001), but not with 5-year overall survival (P=0.074). Hematogenous dissemination rate of patients with muscularis invasion of >50% was significantly higher than that with muscularis invasion of <or=50% (12.9% vs 0.6%, P< 0.001). Lymphatic failure rate of patients with cervical invasion was significantly higher than that without cervical invasion (21.1% vs 3.6%, P< 0.001).
FIGO stage, pathologic grade, depth of muscularis invasion, and cervical invasion are independent prognostic factors in endometrial carcinoma. Comparing with clinical stage, pathohistological stage could assess prognosis more objectively. Deep muscularis invasion is the strongest predictor of hematogenous dissemination; and cervical invasion increases the lymphatic failure rate.
子宫内膜癌已评估了多项预后因素。其中，只有少数因素被认为是独立影响预后的主要不利因素。本研究旨在探索子宫内膜癌的独立预后因素。
回顾性研究1990年1月至2000年12月在我院接受初次手术治疗的265例患者。采用单因素模型和多因素回归模型分析预后因素。
所有患者的5年无复发生存率为83.3%，5年总生存率为84.3%。单因素模型显示，临床分期、病理分期、病理分级、病理亚型、肌层浸润深度、宫颈浸润、淋巴结转移、腹腔细胞学检查、淋巴血管浸润和附件转移与5年无复发生存率及5年总生存率显著相关（P<0.05），而年龄和并发症与预后无显著相关性（P>0.05）。然而，多因素回归分析显示，只有病理组织学分期、病理分级、肌层浸润深度和宫颈浸润与5年无复发生存率及5年总生存率显著相关（P<0.05）；临床分期与5年无复发生存率显著相关（P<0.001），但与5年总生存率无关（P=0.074）。肌层浸润>50%患者的血行播散率显著高于肌层浸润≤50%患者（12.9%对0.6%，P<0.001）。有宫颈浸润患者的淋巴转移失败率显著高于无宫颈浸润患者（21.1%对3.6%，P<0.001）。
国际妇产科联盟（FIGO）分期、病理分级、肌层浸润深度和宫颈浸润是子宫内膜癌的独立预后因素。与临床分期相比，病理组织学分期能更客观地评估预后。肌层深度浸润是血行播散的最强预测因素；宫颈浸润增加淋巴转移失败率。
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