| OBJECTIVE: To summarize clinicopathologic features , treatment and follow-up information of patients with endometrial carcinoma (EC) of our hospital in recent 8 years; to investigate changes in clinical and pathological characteristics of patients with EC via comparing with that of 1989-1995, and to identify parameters predicting the prognosis in EC.METHODS: Clinical and pathological information of 499 patients with EC treated in our hospital from Juan 1996 to Dec 2003 were reviewed. Distribution pattern of these data were compared with that of 1989~1995. And eighty eight percent of all patients were followed up for a period varies from 3 to 108 months. Survival rate were calculated using life table method, and prognosis parameters were analyzed using Wilcoxon-Gehan test and Cox's proportional hazard regression.RESULTS: (1) The mean age of the 499 EC patients was 52.8±9.2 years old. 14.4 percent of them are younger than 45 years old, which accounted for a significantly larger proportion compared with data from Sep 1995 to Sep 2000 in our hospital (P<0.001).(2)Compared with data of our hospital from 1989 to 1995: (1) Percentage of non-endometrioid type (including adenosquamous carcinoma) rised from 5.9% to 14.0%, and percentage of patients grading 3 rised from 7.2%to 20.4%, both increased significantly. (2)The difference between clinical and surgical-pathologic staging was lower in stage I (10.3 %VS 19.7%, PO.05) and similar in stage 11(67.5 %VS 80.5%, P>0.05).(3) Results of Wilcoxon-Gehan test: ? There were 349, 32, 110 and 8 patients of surgical staging I, II, III and IV respectively. The 5-year survival rate of stage I, II and III were 94%, 100% and 75.3% respectively; the 1-year and 2-year survival rate in stage IV was 57.1% and 11.4% respectively. Prognosis was much poorer in advanced stage (PO.05). Compared within surgical stage I, the 5-year survival rate of IC patients was statistically lower than that of IA/IB patients(72.5 % VS 98.6%/96.4%, P<0.05); The 5-year survival rate of patients having disease outside uterus (stage III/IV) was significantly lower than that of patients not having (stage I/II). ? 461 patients had disease of endometrioid type, and the 5-year survival rate of them was statistically higher than that of non-endometrioid type(90.6%vs 72%, PO.01). ?There were 164, 229 and 102 patients of grade 1, 2 and 3 histology respectively, and the 5-year survival rate of grade 3 patients was statistically lower than that of grade 1/2(73.4% vs 95.1 %/ 93.0%, P<0.01). ? The 5-year survival rate of the 138 patients with deep myometrial invasion was statistically lower than that of non/superficial myometrial invasion(69.4%vs 98.6%/95.7%, PO.01). ? In all the 499 patients, lymph node metastasis occurred in 45, and these patients had a significantly lower 5-year survival rate compared with those who did not occur(59.9%vs 92.1%, PO.01). ? The 5-year survival rate of patients undergone lymphadenectomy was statistically higher than that of those did not (90.4%vs 78%, PO.05).?Peritoneal cytology were done in 383 patients and 54(14.1%) of them are positive. There was no statistical difference of the5-year survival rate between patients of positive and negative results (76.0% vs 92.8%, P>0.05). (4) Significant prognostic factors in Wilcoxon-Gehan test above were analyzed by Cox's proportional hazard regression and It indicated that histologic type, surgical-pathological stage, histologic grade, and depth of myometrial invasion had independent prognostic significance in EC. CONCLUSIONS: (1) In recent years, women with EC are younger and younger. Premenopausal women who had menoxenia or hypermenorrhea should exclude the possibility of EC in the first place. Young patients usually had a higher incidence of well differentiated tumor, non/superficial myometrial invasion and endometrioid type in histology than elder ones, and if diagnosed at early stage, they had a rather favorable prognosis. (2) Compared with data during 1989-1995, non-endometrioid type and grade 3 in histology accounts for significantly larger proportions (P<0.05). And the difference between clinical and surgical-pathologic staging in stage II was 67.5%, which is remarkable and similar to that of 1989-1995. (3) Multiple-factor analysis indicated that surgical-pathological stage, histologic type, histologic grade and depth of myometrial invasion had independent prognostic significance in patients with EC whereas age, menopause, peritoneal cytology and lymph node metastasis did not have. (4) The 5-year survival rate of surgical staging I, II and III were 94%, 100%, 75.3% respectively and the 1-year and 2-year survival rate in stage IV was 57.1% and 11.4% respectively, which is approximate to the data reported by FIGO in 2003.
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