Lachance J A, Everett E N, Greer B, Mandel L, Swisher E, Tamimi H, Goff B
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Box 356460, Seattle, WA 98195, USA.
Gynecol Oncol. 2006 Jun;101(3):470-5. doi: 10.1016/j.ygyno.2005.11.009. Epub 2006 Jan 18.
To evaluate the effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer.
All women with surgically treated endometrial cancer at the University of Washington in Seattle, Washington between January 1990 and January 2000 were eligible; 396 patients underwent retrospective chart review. Statistical analysis was performed by SPSS. Median follow-up time was 33 months (range, 1 to 120 months).
Age was < 45 years in 15% of patients, between 46 and 64 years in 47% of patients, and > 65 years in 38% of patients. Younger patients were statistically more obese than older patients (Body Mass Index of 40.3 kg/m2 vs. 35.3 kg/m2 vs. 31.0 kg/m2, P < 0.001). Intraoperatively, there were no differences between the three groups in the percentage of patients with lymph node sampling, operative time, blood loss, or complications. Postoperatively, older patients had more wound infections (P = 0.002), more cardiac events (P = 0.001), and more episodes of ileus (P = 0.025). Evaluation of pathology revealed that patients < 45 years old were statistically more likely to have endometrioid histology, grade I tumors, and stage IA disease. Women over age 65 were significantly more likely to have papillary serous histology, grade 3 tumors, and stage IC as compared to the younger patients. A subset analysis of patients > 75 years of age showed an increase in the percentage of patients with papillary serous histology (22% vs. 3%, P = 0.055), grade 3 disease (42% vs. 16%, P < 0.001), and stage IC disease (21% vs. 3%, P = 0.001) when compared to patients < 45 years old. Evaluation of endometrioid tumors only revealed a similar pattern of deeper myometrial invasion and higher tumor grade as age increased.
Younger patients with endometrial cancer are generally more obese, with lower grade, lower stage disease, and with more favorable histologic cell types. Despite this, approximately a quarter have stage II-IV disease and 9% have positive lymph nodes. The older patients represent a dramatically different subset of patients. They are more likely to have aggressive papillary serous histology, higher grade tumors, and advanced stage disease. Age should be a consideration in appropriate referrals to gynecologic oncologists.
评估年龄对子宫内膜癌患者临床/病理特征、手术并发症及预后的影响。
1990年1月至2000年1月在华盛顿州西雅图市华盛顿大学接受手术治疗的所有子宫内膜癌女性患者均符合条件；对396例患者进行回顾性病历审查。采用SPSS进行统计分析。中位随访时间为33个月（范围1至120个月）。
15%的患者年龄小于45岁，47%的患者年龄在46至64岁之间，38%的患者年龄大于65岁。统计学上，年轻患者比老年患者更肥胖（体重指数分别为40.3kg/m²、35.3kg/m²、31.0kg/m²，P<0.001）。术中，三组患者在淋巴结取样百分比、手术时间、失血量或并发症方面无差异。术后，老年患者伤口感染更多（P=0.002），心脏事件更多（P=0.001），肠梗阻发作更多（P=0.025）。病理评估显示，45岁以下患者在统计学上更可能具有子宫内膜样组织学、I级肿瘤和IA期疾病。与年轻患者相比，65岁以上女性更可能具有乳头状浆液性组织学、3级肿瘤和IC期疾病。对75岁以上患者的亚组分析显示，与45岁以下患者相比，乳头状浆液性组织学患者百分比增加（22%对3%，P=0.055），3级疾病患者百分比增加（42%对16%，P<0.001），IC期疾病患者百分比增加（21%对3%，P=0.001）。仅对子宫内膜样肿瘤的评估显示，随着年龄增加，肌层浸润更深和肿瘤分级更高的模式相似。
年轻的子宫内膜癌患者通常更肥胖，疾病分级较低、分期较低，组织学细胞类型更有利。尽管如此，约四分之一的患者患有II-IV期疾病，9%的患者淋巴结阳性。老年患者是截然不同的患者亚组。他们更可能具有侵袭性的乳头状浆液性组织学、高级别肿瘤和晚期疾病。在适当转诊至妇科肿瘤学家时应考虑年龄因素。
