Xue De-bin, Ding Li-juan, Xia Ai-li, Chen Dong, Xia Hua-ping, Teng Xiao-dong, Xu Shao-ting, Zhang Suo-jiang, Ren Xing-chang
Depatment of Pathology, Ningbo Women and Children's Hospital, Ningbo 315012, China.
Zhonghua Bing Li Xue Za Zhi. 2010 Oct;39(10):671-4.
To study the clinicopathologic features of uterine papillary serous carcinoma (UPSC) and the roles of adjuvant therapy.
Sixty-one cases of UPSC with operation done and followed up for a period of 4 to 9 years were enrolled into the study. The histology of slides specimens were reviewed and immunohistochemical study was performed. The follow-up and survival data were analyzed.
All of the 61 patients were post-menopausal, with a median age of 68 years. The clinical presentations included abnormal vaginal bleeding, abdominal symptoms and abnormal Pap smears. The median size of the tumors was 7.5 cm (range=1.2 to 14.8 cm). There were 27.9% cases in FIGO stage I (8.2% in stage IA, 14.8% in stage IB and 4.9% in stage IC), 9.8% in stage II, 32.8% in stage III and 29.5% in FIGO stage IV. The histologic features were similar to those of the ovarian counterpart, with tumor cells containing the high-grade nuclei and arranged in complex papillae. Psammoma bodies were identified in 24.6% of the cases. Immunohistochemical study showed that the tumor cells demonstrated diffuse and strong nuclear staining for p53 and Ki-67. They were negative for estrogen receptor and progesterone receptor. Fifteen of the 61 cases (24.6%) showed no evidence of myometrial invasion. However, ten of the 15 cases had extrauterine disease, with peritoneal (6/15) and nodal (9/15) involvement. Tumors with deep myometrial invasion, lymphovascular permeation and nodal metastasis were associated with worse prognosis by univariate analysis. Fifty-six patients received adjuvant therapy. The number of patients receiving adjuvant chemotherapy alone, adjuvant radiotherapy alone and combined adjuvant chemotherapy/radiotherapy were 42, 24 and 10, respectively. The median survivals of the chemotherapy group and non-chemotherapy group (with or without radiotherapy) were 66.4 months and 32.8 months, respectively.
UPSC has distinctive clinical and pathologic features. The tumor stage, lymph node status, lymphovascular permeation and depth of myometrial invasion were important prognostic factors. Adjuvant chemotherapy for stage III/IV tumors or recurrent UPSC may have survival benefit.
研究子宫浆液性乳头状癌（UPSC）的临床病理特征及辅助治疗的作用。
本研究纳入61例行手术治疗且随访4至9年的UPSC患者。对切片标本进行组织学复查并开展免疫组化研究。分析随访及生存数据。
61例患者均为绝经后女性，中位年龄68岁。临床表现包括阴道异常出血、腹部症状及巴氏涂片异常。肿瘤中位大小为7.5 cm（范围1.2至14.8 cm）。国际妇产科联盟（FIGO）分期中，I期占27.9%（IA期8.2%、IB期14.8%、IC期4.9%），II期占9.8%，III期占32.8%，IV期占29.5%。组织学特征与卵巢浆液性乳头状癌相似，肿瘤细胞核分级高，呈复杂乳头样排列。24.6%的病例可见砂粒体。免疫组化研究显示，肿瘤细胞p53和Ki-67呈弥漫性强核染色。雌激素受体和孕激素受体均为阴性。61例中有15例（24.6%）无肌层浸润证据。然而，这15例中有10例存在子宫外病变，包括腹膜转移（6/15）和淋巴结转移（9/15）。单因素分析显示，肌层浸润深度深、脉管浸润及淋巴结转移的肿瘤预后较差。56例患者接受了辅助治疗。单纯接受辅助化疗、单纯接受辅助放疗及联合辅助化疗/放疗的患者分别为42例、24例和10例。化疗组和非化疗组（无论是否接受放疗）的中位生存期分别为66.4个月和32.8个月。
UPSC具有独特的临床和病理特征。肿瘤分期、淋巴结状态、脉管浸润及肌层浸润深度是重要的预后因素。对III/IV期肿瘤或复发性UPSC进行辅助化疗可能有益生存。
