改良根治性子宫切除术在Ⅰ期中危子宫内膜样腺癌中的治疗价值研究

发布时间：2018-06-04 23:40

  本文选题：子宫内膜样腺癌 + 改良根治性子宫切除术　； 参考：《复旦大学》2014年博士论文

【摘要】：目的：探讨改良根治子宫切除术在Ⅰ期中危子宫内膜样腺癌患者中的治疗价值。主要结局为局部复发率,次要结局为专病死亡率、手术相关并发症发生率。评估改良根治子宫切除术是否可以在不降低局部控制率和生存获益的前提下,减少Ⅰ期子宫内膜样腺癌患者的治疗相关并发症,代替辅助放疗作为患者的另一治疗选择。材料与方法：回顾性分析复旦大学肿瘤医院2004年1月至2008年12月期间收治的初治行改良根治子宫切除术的子宫内膜样腺癌患者的临床病理资料,根据复旦大学肿瘤医院妇科肿瘤诊疗指南标准筛选出中危亚组患者,应用Kaplan-Meier法对中危组患者的复发、生存情况进行分析；应用cox回归法对影响预后的因素进行分析；统计手术时间、出血量、输血比率、输血量、手术相关并发症。结果：共有328例Ⅰ期(Federation International of Gynecology and Obstetrics 2009, FIGO 2009)子宫内膜样腺癌患者在我院初治行改良根治性子宫切除+双附件切除±盆腔淋巴结清扫±腹主动脉旁淋巴结清扫+腹腔冲洗液细胞学检查。其中中危组患者共168例,高中危组(high-intermediate risk, HIR)38例,低中危(low- intermediate risk, LIR)组130例。中位随访时间69.5个月(50.8-85.25月)；9例患者术后复发：3例局部复发(阴道复发或盆腔复发),6例远处转移；3例死于子宫内膜癌。所有复发患者的中位无进展生存期为40个月(17-46月),中位生存时间为65个月(27-78.5月)；中危患者中有27%行辅助治疗,总体的3年和5年的累积孤立局部复发率皆为1.4%,肿瘤专病生存率为98.6%和97.8%。高中危组和低中危组3年和5年累积总局部复发率分别为0%和0%vsl.7%和1.7%(x2=0.825,P=0.346)；专病生存率为100%和93.3%vs98.2%和98.2%(x 2=0.242,P=0.623)。中危组未行辅助治疗的患者,3年、5年生存率分别为99.0%和98.0%；3年、5年累积局部复发率分别为1%。高中危组中未行辅助治疗组3年、5年专病生存率分别为100%和90%,累积局部复发率分别为0；低中危组未行辅助治疗的患者3年、5年专病生存率分别为98.9%；累积局部复发率分别为1.1%。168例中危患者中,中位手术时间为130min(107-150min),中位出血量为300ml (200-400ml)。21例患者术中或术后接受输血,输血比率为12.5%(21/168)。手术相关并发症发生率4.8%,其中泌尿生殖系统并发症发生率为1.8%。结论：本研究中行改良根治子宫切除术的中危组患者,辅助治疗施行率低,而局部控制效果、生存获益较好,手术相关并发症发生率低。
[Abstract]:Objective: to evaluate the value of modified radical hysterectomy in the treatment of stage I endometrial adenocarcinoma. The main outcome was local recurrence rate, the secondary outcome was specific mortality, and the incidence of operation-related complications. To evaluate whether modified radical hysterectomy can reduce treatment-related complications in patients with stage I endometrial adenocarcinoma without reducing the local control rate and survival benefit, instead of adjuvant radiotherapy as another treatment option. Materials and methods: the clinical and pathological data of patients with endometrial adenocarcinoma treated by modified radical hysterectomy in Fudan University Cancer Hospital from January 2004 to December 2008 were analyzed retrospectively. According to the criteria for diagnosis and treatment of gynecological tumors in Fudan University Cancer Hospital, the patients in the middle risk subgroup were screened out, the recurrence and survival of the patients in the middle risk group were analyzed by Kaplan-Meier method, the factors influencing the prognosis were analyzed by cox regression method. Operation time, blood loss, blood transfusion ratio, blood transfusion volume, and complications associated with surgery were counted. Results: a total of 328 patients with stage 鈪，

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