【摘要】  　　方针： 探讨晚期子宫内膜癌复发特征及其相关身分。体例: 回首回头回忆性剖析1994年7月至2005年8月收治的182例子宫内膜癌患者，斗劲晚期癌症中复发（14例）与未复发（36例）患者的临床病例资料。功效: 50例晚期子宫内膜癌患者，中位随访时刻55个月（4月～12年），复发转移14例，总复发率28.0%，平均无瘤保留期21.5个月；12例Ⅲ期患者中, Ⅲa期9例,复发率26.5%,平均无瘤保留期25.4个月；Ⅲc期3例，复发率25%，平均无瘤保留期12.5个月；Ⅳ期2例,复发率50.0%,平均无瘤保留期11.0个月。分歧病理分级的平均无瘤保留期：G123.9个月，G219.6个月，G312个月；分歧复发部位的平均无瘤保留期：盆腹腔22.3个月，腹膜后淋巴结转移13个月，骨转移30个月。14例复发转移患者弃世亡13例，平均保留期43.6个月，其中Ⅲ期45个月，Ⅳ期36个月。深肌层侵润(侵润肌层≥1/2)者复发率为42.9%，浅肌层侵润(侵润肌层<1/2)者复发率为17.2%，差别有统计学意义；低剖析癌（G3）的复发率为61.5%，较着高于平剖析癌（G2）和高剖析癌（G1）的复发率，分袂为33.3%和12.5%。多身分剖析浮现，侵肌深度和肿瘤剖析水平是影响晚期子宫内膜癌复发的自力相关身分（P<0.05）；年龄、手术病理分期、病理典型、淋巴结转移、腹腔细胞学搜检以及术后扶助化疗不是影响肿瘤复发的自力相关身分(P>0.05)。结论: 晚期子宫内膜癌复发率高，最常见的复发转移部位为盆腹腔，年夜都在2年内复发，影响复发转移的自力相关身分为肿瘤剖析水平和深肌层浸润。

【关头词】  子宫内膜癌 复发 无瘤保留期 剖析

　　Characteristics and Related Factors of Recurrence and Metastasis

　　of Advanced Endometrial Carcinoma

　　Chen Chun-ling,Ma Ke,Liao Qin-ping,et al.

　　Department of Obstaries and Gynecology, Peking University First Hospital, Beijing 100034, China

　　【ABSTRACT】 Objective: To study the characteristics and related factors of recurrence and metastasis in advanced endometrial carcinoma. Methods: The clinic-pathological features of 50 patients with advanced endometrial carcinoma among 182 endometrial cancer, admitted during July 1994 to August 2005, were analyzed retrospectively. Among them, 14 cases with recurrence and metastasis were compared with those without recurrence and metastasis. Results: 14 patients were found with recurrence and metastasis among 50 advanced stage cases, the median follow-up was 55 months ( 4 months～12 years). The total recurrence rate was 28.0%, of which, stage Ⅲ was in 12 and stage Ⅳ was 2. Eleven cases of metastasis were presented firstly in pelvic and peritoneal cavity. The recurrence rate was 50% in stage Ⅳ, 26.5% in stage Ⅲa and 25% in stage Ⅲc. The average Progression Free Survival (PFS) was 11 months in stage Ⅳ, 25.4 months in Ⅲa and 12.5 months in Ⅲc. The PFS was 12 months in G1,19.6 months in G2,23.9 months in G3. 13 patients died from recurrence and metastasis, the mean overall survival was 43.6 months, of which, stage Ⅲ was 45 months, stage Ⅳ was 36 months. The relapse rate was higher in the cases with deep myometrial invasion(≥1/2, 42.9%; <1/2, 17.2%)；The recurrence rate of low-differentiated cases (G3,61.5%) was significantly higher than that of moderate (G2,12.5%) and high-differentiated cases (G1,33.3%)；The independent prognosis factors of recurrence and metastasis included differentiation and myometrial invasion(P<0.05). Age, pathological type, lymph node involvement, peritoneal cytological test and adjuvant chemotherapy were not independent prognostic factors of recurrence (P>0.05). Conclusion: The recurrence rate was higher in advanced endometrial carcinoma. The most common sites of recurrence and metastasis were pelvic and peritoneal cavity. The average time of recurrence and metastasis was usually less than 2 years. The independent prognosis factors of recurrence and metastasis included differentiation and myometrial invasion.

　　【KEY WORDS】 Endometrial carcinoma； Recurrence； Progression free survival； Differentiation

　　子宫内膜癌是女性生殖系统常见恶性肿瘤之一，70%～90%的患者因为不端方阴道流血及排液增多而获得早期诊断，仅少数患者就诊时已为晚期。为了探讨晚期子宫内膜癌复发转移的临床特征及相关身分，本文对10余年来收治的晚期子宫内膜癌复发和转移患者的临床资料进行回首回头回忆性剖析。

　　1 资料与体例

　　1.1 临床资料

　　收集1994年7月至2005年8月北京年夜学第一临床病院妇产科收治的具有随访资料的182例子宫内膜癌,其中晚期子宫内膜癌（Ⅲ、Ⅳ期）病例50例，全数病例均经手术病理证实。晚期子宫内膜癌的治疗，首选手术治疗，根据术后病理抉择扶助化疗或（和）放疗等。全数患者系统治疗后均门诊随访，第1年每月一次，第2～3年每3个月一次，往后每6个月一次。随访内容搜罗妇科搜检、阴道断端细胞学搜检、阴道B超、血清肿瘤标识表记标帜物CA125测定等。可疑复发或转移者，进一步CT或MRI搜检。随访时刻4个月～12年，中位随访时刻55个月。

　　1.2 体例

　　182例子宫内膜癌患者中早期（Ⅰ、Ⅱ期）132例，晚期（Ⅲ、Ⅳ期）50例，斗劲早期患者和晚期患者的复发率；将50例晚期子宫内膜癌患者按有无复发转移分为两组，复发组14例，未复发组36例，斗劲复发转移的高危身分、临床病理特征及治疗体例。

　　1.3 统计体例

　　接纳SPSS13.0统计软件进行统计学剖析。复发相关身分剖析接纳COX回归筛选，复发率的斗劲接纳Kaplan-Meier磨练，P<0.05为差别有统计学意义。