Clinical Analysis Of 600 Cases With Endometrial Carcinoma

Objective:To analyze retrospectively the clinical informa- tion of 600 patients with endometrial carcinoma during 10 years in the Fourth Hospital of Hebei Medical University. To evaluate the related risk factors affecting prognosis and the relationship between various clinicopathologic factors.Methods:The clinicopathologic factors and outcomes of 600 patients with endometrial carcinoma underwent primary surgical treatment and confirmed by pathology from Jan 1997 to Dec 2006 in the Fourth Hospital of Hebei Medical Universit- y were reviewed and analyzed. An Excel database was built with clinical follow-up survey and analyze the prognostic factors of the endometrial carcinoma.SPSS 13.0 software package was used.Survival rates were calculated using Kaplan-Meier method. The prognostic factors were evaluated by univariate and multivariate analysis. Univariate analysis and the comparison between the survival rates was estimated by log-rank test. Multiple regression analysis were assessed by Cox proportional hazards model. Enumeration data were compared withχ2 test. A statistically significant difference was indicated by P<0.05.Results: 1 The average survival time of 600 cases with endometrial carcinoma was (57.39±33.55) mo (2~136.5mo), the median survival time 49.05 mo,and the death-associated 109(18.2%)2 The 1-year, 3-year, 5-year overall survival rates after surgery were 96.8%,89.9%,82.1%,respectively.3 The average age was 54.93±8.36 years old (26~78 years old). the median age was 55 years old; <55 acount for 47.7%,≥55 52.3%.4 Except histological type and operation-pathological stage, th- ere were significant differences in pathologic grade, depth of muscularis invasion between the different age groups (P<0.05). The <55 group has well differentiated , less deep myometrial invasion, while the≥55 group has countrary results.5 When the premenopausal group was compared with the post- menopausaul group, the pathologic grade was lower, the depth of myometrial invasion was less, the differences were signifi- cant(P<0.05).There were no significant differences in histological type and operation-pathological stage between the two groups (P>0.05).6 Univariate analysis revealed that age,menopausal state, histo- logical type,tumor grade, operation-pathological stage,tumor size,depth of myometrial invasion,cervical invasion, ovarian metastasis, lymph node metastasis, treatment modality were significantly associated with the overall-survival. Multivariate analysis revealed that histological type, tumor grade, operation-pathological stage, cervical invasion were associated significantly with overall-survival.7 Comparison of various clinicopathologic factors related to ovarian metastasis, there were significant differences in tumor grade,depth of myometrial invasion,cervical invasion, tumor site,tumor size,lymph node metastasis(P<0.05),except age and histological type. The incidence of ovarian metastasis increased in patients with poorly differentiated tumor, deep myometrium invasion, cervical involvement, tumor full of uterine cavity, lymph node metastasis.8 Comparison of various clinicopathologic factors related to lymph node metastasis ,there were significant differences in tumor grade,depth of myometrial invasion,cervical invasion, ovarian metastasis (P<0.05), except age, histological type, tumor site,tumor size. The incidence of lymph node metastasis increased in patients with poorly differentiated tumor,deep myometrium invasion,cervical involvement, ova- rian metastasis.9 Patients with stageⅠendometrial carcinoma underwent sim- ple hysterectomy and salpingo-oophorectomy, subradical hysterectomy, radical hysterectomy. Five-year survival rates were 85.8%,93.4%,92.4%,respectively(P>0.05). The 5-year survival in patients undergoing lymphadenectomy was 92.3%, and it was 89.4% in patients without lymphaden- ectomy, there was no difference statistically(P>0.05). Conclusion:1 When the younger women and premenopausal group compar- ed with the old and postmenopausaul group, the tumor grade is lower, the deep myometrial invasion is less.2 Factors associated with prognosis are: age, menopausal state, histological type, tumor grade, operation-pathological stage, tumor size, depth of myometrial invasion, cervical invasion, ovarian metastasis,lymph node metastasis, treatme- nt modality.3 The independent prognostic factors are: histological type, tumor grade, operation-pathological stage, cervical invasion.4 Poorly differentiated, deep myometrium invasion, cervical involvement, tumor site,tumor size, lymph node metastasis are the high risk factors for ovarian metastasis in endomet- rial carcinoma.5 The high risk factors for lymph node metastasis in endometri- al carcinoma include poorly differentiated, deep myome- trium invasion, cervical involvement, ovarian metastasis.6 The surgical range has not affected prognosis of stageⅠendometrial carcinoma. Extensive surgical range of stageⅠendometrial carcinoma does not increase the survival rate.7 The prognosis of endometrial carcinoma is closely related to clinic-pathological features.We should assess systematicly prognostic correlative factors of endometrial carcinoma, work out a therapeutic schedule individually,to acquire well curative effect.