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子宫内膜癌子宫外转移的高危因素分析

发布时间:2018-04-01 22:10

  本文选题:子宫内膜癌 切入点:子宫外转移 出处:《郑州大学》2014年硕士论文


【摘要】:背景和目的 子宫内膜癌(endometrial cancer, EC)是妇科常见的恶性肿瘤,近年来在全球范围内,其发病率呈逐年上升趋势,其发病率在欧美等发达国家已超过宫颈癌,跃居第一位[1]。在我国,,目前缺少确切的发病率,但在北京及上海,据统计其发病率已成为女性生殖道恶性肿瘤的首位[2]。其严重威胁了女性的健康及生活质量。恶性肿瘤最主要的特性为转移,转移成为影响患者生存及预后的主要因素,子宫内膜癌患者子宫外转移包括淋巴结转移、输卵管转移、卵巢转移及腹膜转移等。随着现代医学的发展,微创内镜在妇科方面的应用越来越广,使得较多的子宫内膜癌患者能早期治疗。2006年,FIGO公布了对1962-2001年间子宫内膜癌患者生存率研究的结果,其生存率已由63%提高到80%[3]。为了进一步提高患者的生存率,除了早期诊断及合理治疗外,也应该注意患者存在的风险因素,准确的评估预后,制定一个个体化的辅助治疗方案,最大程度的提高患者生存时间。 本文旨在通过回顾性分析子宫内膜癌患者的临床、病理及分子生物学指标等情况,了解EC宫外转移的高危因素,为子宫内膜癌的诊治提供一定的指导。 材料和方法 搜集2009年1月至2013年10月于郑州大学第二附属医院治疗的149例子宫内膜癌患者,患者临床资料完整,所有患者均行手术治疗,术前未进行过化疗、放疗及内分泌治疗等,无其他合并肿瘤,并按照国际妇产科联盟2009年修订的子宫内膜癌手术-病理分期标准分期,其中I期患者行筋膜外子宫全切术+双附件切除术,有高危因素(特殊病理类型、组织细胞分化差等)或可疑盆腔及腹主动脉旁淋巴结肿大者行盆腔淋巴结及腹主动脉旁淋巴结清扫术或取样术,II期患者行广泛或次广泛子宫全切术+双附件切除术+盆腔淋巴结及腹主动脉旁淋巴结清扫术,III期患者行肿瘤细胞减灭术。 回顾性分析149例患者的年龄、绝经情况、病理类型、组织学分级、肌层浸润深度及EC的高危因素(高血压、糖尿病及肥胖)。回顾性分析149例患者中行免疫组化SP法检测的104例患者的雌激素受体(estrogen receptor,ER)、103例患者的孕激素受体(progesterone receptor,PR)、104例患者的肿瘤蛋白53(tumorprotein53,P53)及行放射免疫法检测的98例患者癌抗原125(cancer antigen125,CA125)的表达情况,分析子宫内膜癌子宫外转移的高危因素。 应用SPSS17.0统计软件包对数据进行统计分析,采用χ2检验和Fisher确切概率法进行计数资料分析,多因素采用Logistic回归模型分析,以P0.05为有统计学意义。 结果 1.子宫内膜癌发病年龄分布于27-80岁,平均发病年龄为56.53±9.047岁,已绝经者104例,占69.79%(104/149),未绝经者45例,占30.21(45/149)。 2.149例患者中子宫外转移者共13例,占8.72%(13/149),其中淋巴结转移者7例,构成比为53.84%(7/13),最常见,其次为输卵管转移者3例,构成比为23.07%(3/13),其余3例为多部位子宫外转移,包括1例出现了输卵管、卵巢、肠系膜和腹水的转移,1例卵巢及输卵管均有转移,1例有盆腔淋巴结及腹膜的转移。 3.统计分析表明,特殊病理类型、组织学分级3级、肌层浸润深度≥1/2、ER阴性、PR阴性、CA125阳性及伴高危因素(高血压、糖尿病及肥胖)的子宫内膜癌患者的子宫外转移率高(P0.05),高-中分化组织、P53表达情况、绝经情况及年龄对子宫内膜癌子宫外转移无明显影响(P0.05),多因素Logistic回归模型分析表明,特殊病理类型、组织学分级3级、肌层浸润深度≥1/2及子宫内膜癌的高危因素(高血压、糖尿病及肥胖)不是子宫内膜癌子宫外转移的独立影响因素。 结论 1.子宫内膜癌子宫外转移最常见的是淋巴结转移,其次为输卵管转移,有少部分患者表现为输卵管、卵巢及腹膜等多部位转移。 2.特殊病理类型、组织学分级3级、肌层浸润深度≥1/2、ER阴性、PR阴性、CA125阳性及伴子宫内膜癌的高危因素(高血压、糖尿病及肥胖)是子宫内膜癌子宫外转移的高危影响因素。
[Abstract]:Background and purpose
Endometrial cancer (endometrial cancer EC) is a common gynecological malignant tumor in the world in recent years, its incidence increased year by year, the incidence rate in Europe and other developed countries have been more than cervical cancer, ranked first in the [1]. in our country, there is a lack of exact incidence, but in Beijing and Shanghai according to statistics, the incidence rate of [2]. has become the first malignant tumor of the female genital tract of the serious threat to the health and quality of life of women. The most important feature of malignant tumor metastasis, metastasis is the main factor affecting the survival and prognosis of patients, patients with uterine endometrial carcinoma metastasis including lymph node metastasis, tubal ovarian metastasis. Metastasis and peritoneal metastasis. With the development of modern medicine, minimally invasive endoscopic application is more and more widely in gynecology, that many patients with endometrial cancer can be early treatment for.2006 years, FIGO announced on the 1962-200 The 1 years survival rate of patients with endometrial cancer research results, the survival rate has increased from 63% to 80% in 3. In order to further improve the survival rate of patients, in addition to early diagnosis and reasonable treatment, should also pay attention to the risk factors of patients, accurate assessment of prognosis, treatment plan of one individual the survival time of the patients, increase the maximum degree.
The purpose of this study is to understand the risk factors of EC extrauterine metastasis by retrospective analysis of the clinical, pathological and molecular biological indicators, and provide guidance for the diagnosis and treatment of endometrial cancer.
Materials and methods
149 cases of endometrial cancer patients were collected from January 2009 to October 2013 in the Second Affiliated Hospital of Zhengzhou University of treatment, patients with complete clinical data, all patients underwent surgical treatment, preoperative without chemotherapy, radiotherapy and endocrine therapy, no other tumor, and in accordance with the operation of endometrial carcinoma in 2009 revision of the International Federation of gynecology and obstetrics staging the standard stage, stage I underwent extrafascial hysterectomy + double oophorectomy, high risk factors (special pathological type, cell differentiation etc.) or suspected pelvic and paraaortic lymph node enlargement for pelvic lymph nodes and para aortic lymph node dissection or biopsy in patients with II. During the period of either extensive hysterectomy + double appendix resection and pelvic lymph nodes and para aortic lymph node dissection, tumor cells were treated with III during cytoreductive surgery.
A retrospective analysis of 149 cases of patients with age, menopausal status, pathological type, histological grade, myometrial invasion and EC risk factors (hypertension, diabetes and obesity). A retrospective analysis of 149 cases of estrogen receptor 104 patients underwent SP immunohistochemical method to detect the patients (estrogen receptor, ER), progesterone receptor 103 patients (progesterone receptor, PR), 104 patients with tumor protein 53 (tumorprotein53, P53) in 98 patients with cancer antigen detection and radioimmunoassay for 125 (cancer antigen125 CA125) expression, the risk factors of endometrial cancer metastasis outside the uterus.
SPSS17.0 statistical software package was applied to analyze the data. Chi square test and Fisher exact probability method were used to analyze the count data. Multiple factors were analyzed by Logistic regression model. P0.05 was statistically significant. Logistic regression analysis showed that the data were statistically significant.
Result
1., the onset age of endometrial cancer is 27-80 years old, the average age of onset is 56.53 + 9.047 years, 104 cases of menopause, 69.79% (104/149), and 45 cases of non menopausal women, accounting for 30.21 (45/149).
In 2.149 patients of uterine metastasis were 13 cases, accounting for 8.72% (13/149), including 7 cases of lymph node metastasis, accounting for 53.84% (7/13), the most common, followed by 3 cases of tubal metastasis, accounting for 23.07% (3/13), and 3 cases of multiple sites of metastasis. Including 1 cases of oviduct, ovarian metastasis, mesentery and ascites, 1 cases of metastasis were ovary and fallopian tube, 1 cases of metastatic pelvic lymph node and peritoneal.
3. statistical analysis showed that the special pathological type, histological grade, 3 grade, myometrial invasion depth more than 1/2, ER negative, PR negative, CA125 positive and with risk factors (hypertension, diabetes and obesity) of the patients with carcinoma of endometrium outside the uterus high transfer rate (P0.05), high - in differentiated tissues, the expression of P53 the situation, menopausal status and age of uterine endometrial carcinoma metastasis has no significant effect (P0.05), multi factor Logistic regression analysis showed that, the special pathological type, histological grade, 3 grade, myometrial invasion depth more than 1/2 and endometrial cancer risk factors (hypertension, diabetes and obesity) were not independent factors of endometrial carcinoma of the uterine metastasis.
conclusion
1., the most common extrauterine metastasis of endometrial carcinoma is lymph node metastasis, followed by tubal metastasis. A few patients are metastatic to the multiple parts of the fallopian tube, ovary and peritoneum.
2. special pathological type, histological grade, 3 grade, myometrial invasion depth more than 1/2, ER negative, PR negative, positive and risk factors associated with endometrial cancer CA125 (hypertension, diabetes and obesity) are high risk factors of endometrial cancer metastasis outside the uterus.

【学位授予单位】:郑州大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R737.33

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