年轻妇女子宫内膜癌51例临床分析
发布时间：2018-08-08 16:07
【摘要】：背景： 子宫内膜癌（endometrial carcinoma, EC）的治疗是把双刃剑，在治疗肿瘤的同时，治疗方法本身也会带来很多副作用，从而影响到患者的器官功能和生活质量。在以往谈“癌”色变的思想影响下，很多患者甚至医生认为，，只要能把肿瘤治好，丧失生育器官和功能也是理所当然的。2l世纪，医学由单一的“生物学”模式正向着“生物-心理-社会”模式转变。年轻EC患者的治疗在提高良好预后的同时，手术造成的永久性不孕和人工绝经的显著负面影响促使我们思考：能否根据患者的病情及其意愿，通过多学科协作，为其提供更个体化的治疗？目的：分析年轻EC患者临床、病理特征，探讨个体化治疗的可行性。方法：回顾性分析并随访2008～2012年51例年轻EC (年龄≤40岁)临床资料，采用Kaplan-Meier方法计算生存曲线，采用Log-Rank检验进行各组间生存率的比较，采用COX生存模型分析影响预后的相关因素。结果：1.88.2%的病例为子宫内膜样腺癌；68.6%为G1和G2;60.8%无和≤1/2肌层浸润;86.3%PR阳性、90.9%ER阳性。2.手术-病理分期期别的增加，患者死亡的风险增高（RR=3.32）。2.是否保留卵巢是影响生存时间的独立危险因素（RR=2.185）。3.腹水细胞学阳性是淋巴结转移的高危因素（P＜0.05）。4.肿瘤类型、分化程度、术后辅助化疗与术后5年的生存率之间没有统计学意义（P0.05）。结论：1.年轻EC患者的手术-病理分期是预测预后的重要因素，高期别EC是预后不佳的信号。EC的早期诊断和治疗意义重大。2.腹水细胞学阳性是淋巴结转移的高危因素，提示腹水或腹腔冲洗液的细胞学检查仍有一定的价值。3.对于年轻未育的IA期EC患者，对孕激素治疗有效，可以在严密监测下推迟手术时间，争取妊娠机会。4.对于IA期年轻EC患者，雌孕激素受体均为阳性，在手术中可以适度考虑保留卵巢，提高患者的生活质量。5．对于行全面分期手术切除卵巢的患者，无高危复发因素者(早期、高分化，肌层浸润＜1/3，雌激素受体和腹水冲洗液均阴性)，根据实际情况进行激素替代治疗（HRT）。对于有HRT使用禁忌证、慎用情况和不愿意使用的患者，可选择其他非激素制剂来缓解人工绝经症状。6.术后辅助化疗不能提高患者生存率，防止过度治疗。
[Abstract]:Background: the treatment of endometrial carcinoma (endometrial carcinoma, EC) is a double-edged sword. At the same time, the treatment will bring a lot of side effects, thus affecting the organ function and quality of life of patients. Under the influence of the idea of "cancer" color change in the past, many patients and even doctors believe that as long as the tumor can be cured, the loss of reproductive organs and functions is also natural in the .21th century. Medicine is changing from a single biological model to a biological-psychological-social model. While the treatment of young EC patients improves the good prognosis, the significant negative effects of surgery on permanent infertility and artificial menopause prompt us to think about the possibility of multidisciplinary collaboration based on the patient's condition and willingness. To provide a more individualized treatment? Objective: to analyze the clinical and pathological features of young EC patients and to explore the feasibility of individualized treatment. Methods: the clinical data of 51 cases of young EC (age 鈮
本文编号：2172312
[Abstract]:Background: the treatment of endometrial carcinoma (endometrial carcinoma, EC) is a double-edged sword. At the same time, the treatment will bring a lot of side effects, thus affecting the organ function and quality of life of patients. Under the influence of the idea of "cancer" color change in the past, many patients and even doctors believe that as long as the tumor can be cured, the loss of reproductive organs and functions is also natural in the .21th century. Medicine is changing from a single biological model to a biological-psychological-social model. While the treatment of young EC patients improves the good prognosis, the significant negative effects of surgery on permanent infertility and artificial menopause prompt us to think about the possibility of multidisciplinary collaboration based on the patient's condition and willingness. To provide a more individualized treatment? Objective: to analyze the clinical and pathological features of young EC patients and to explore the feasibility of individualized treatment. Methods: the clinical data of 51 cases of young EC (age 鈮
本文编号：2172312
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