| Objective:Through the comparative analysis of clinical data of 204 patients with low differentiation endometrial carcinoma and 44 patients with endometrial clear cell carcinoma,it provides some references for the diagnosis,treatment and prognosis judgment of future G3 EEC and ECCC.Methods:The clinical data of G3 EEC patients(204 cases)and ECCC patients(44 cases)from January 1,2010 to December 31,2017 in Jiangxi Maternal and Child Health Hospital were analyzed retrospectively :(1)Clinical features: onset age,menarche,menopause,pregnancy and childbirth,first-episode symptoms,complications(diabetes mellitus,hypertension,obesity);(2)Preoperative examination: detection Ca125 tumor markers in blood before operation;(3)Postoperative pathological features;(4)Immunohistochemical results;(5)Misdiagnosis and missed diagnosis;(6)Prognostic analysis.Results:1、The mean onset age of G3 EEC patients was 54.61±7.12 years,and that of ECCC patients was 57.14±8.36 years.ECCC mean onset age of patients was greater than that of G3 EEC patients,the difference between the two groups was statistically significant(P<0.05).2、There was no significant difference in median menarche age(15(14,17)years VS 15(14,16)years),menarche age >16 years(32.35% VS 22.73 %),median menopausal age(50(48,53)years VS 51(48,53)years),menopausal age ≥55years,and no births(P >0.05).The difference of menopause(71.64% VS 86.36 %)in G3 EEC patients and ECCC patients was statistically significant(P <0.05).3、There was no significant difference between G3 EEC patients and ECCC patients with abnormal uterine bleeding(93.14% VS 90.91%)and lower abdominal distention pain(2.94% VS 6.82%)(P >0.05).The first symptoms of G3 EEC patients and ECCC patients were vaginal fluid(10.29% VS 25.00%),multiple symptoms(abnormal uterine bleeding,vaginal fluid,lower abdominal distention pain ≥ two symptoms)(4.41% VS 22.73%)were statistically significant(P <0.05).Among them,the difference between the first symptom and multiple symptoms was very significant(P <0.001).4、There was no significant difference between G3 EEC patients and ECCC patients with obesity(8.63% VS 16.28%),diabetes(7.84% VS 4.55%)and hypertension(21.08% VS 29.55%)(P >0.05).5、There were 32 patients with preoperative Ca125>35 U/ml in G3 EEC group,16.49% of total(32/194).The pathological stage of preoperative blood Ca125>35U/ml was advanced(III-IV)in 18 patients.accounting for 56.25 % of total(18/32).Preoperative blood Ca125≤ 35 U/ml 32 patients with advanced stage(III-IV stage),19.75% of total(32/162),And there was no statistical difference between the two(P>0.05).There were 13 patients with preoperative blood Ca125>35U/ml in ECCC group,accounting for 30.23% of the total(13/43).Preoperative blood Ca125> 35 U/ml patients with advanced stage(III-IV stage)6 cases,46.15% of total(6/13).Preoperative blood Ca125 ≤ 35 U/ml patients with advanced stage(III-IV stage)9 cases,30.00% of total(9/30),and there was no statistical difference between the two(P>0.05).6、G3EEC patients and ECCC patients had III-IV stage(advanced stage)(25.49% VS 34.09%)、 The tumor is confined to the lower part of the uterine cavity(10.45% VS 12.20%)、Tumor diameter >2 cm(74.62% VS 75.00%)、Deep myometrium infiltration(>1/2 myometrium)(36.76% VS 36.36%)、 Cervical interstitial infiltration(18.63% VS 29.55%)、Carcinoma embolus(29.90% VS20.50%),the difference was not statistically significant(P > 0.05).There were significant differences in pelvic lymph node metastasis(11.50 % VS 29.55 %)and para-aortic lymph node metastasis(5.52% VS 19.05%)in G3 EEC and ECCC patients(P < 0.05).7、 There were statistically significant differences in ER positive(74.33% VS36.59%),PR positive(67.74% VS 67.74%),Vimentin positive(43.67% VS 61.54%)and P53 positive(9.50% VS 61.54%)in G3 EEC patients and ECCC patients(P <0.05).The difference of ER positive and PR positive in G3 EEC patients and ECCC patients was significant(P < 0.001).8、 Misdiagnosis rate of curettage in G3 EEC group and ECCC group as follows:(33.68% VS 39.02%),The rate of curettage missed in G3 EEC group and ECCC group respectively(61.76% VS 2.44%)。There was no significant difference in misdiagnosis rate and missed diagnosis rate between the two groups(P > 0.05).9、the five-year PFS of G3 EEC and ECCC groups were 83.1% and 88.1%,respectively.Log-rank test results showed no statistical significance(χ2 = 0.42,P =0.517).The five-year OS of G3 EEC group and ECCC groups were 84.2% and 88.1%,respectively.Log-rank test results showed no significant difference(χ2 = 0.416,P =0.519).10、A single factor analysis in G3 EEC patients,Factors significantly associated with OS include positive ascites cytology(P=0.0069),and III-IV stage(late stage)of surgical pathology(P=0.0185,P=0.0001).Based on single factor analysis,Prognostic analysis of multiple factors,the results showed that III-IV stage(late stage)(P=0.0127,P=0.0022)was an independent risk factor for G3 EEC prognosis A single factor analysis in ECCC patients,。During the univariate analysis of ECCC patients,factors significantly associated with OS include cervical interstitial infiltration.(P=0.0327)、Bilateral lymph node metastasis(P=0.0062)、 III-IV stage(late stage)of surgical pathology(all P<0.0001).Based on single factor analysis,a multivariate prognostic analysis was performed,the results showed that the III-IV stage(all P<0.0001)was an independent risk factor for ECCC prognosis。Conclusions:1、G3EEC mean onset age is less than ECCC,ECCC most occur in postmenopausal women,the clinical symptoms of both lack specificity,vaginal drainage symptoms are more common in ECCC.When the initial symptoms are multiple,ECCC to be excluded first.2、 Preoperative blood Ca125 has no obvious effect on G3 EEC and ECCC preoperative tumor stage diagnosis.3、 Compared with the G3 EEC,ECCC,there is a stronger tendency of distant metastasis,and this factor should be fully considered in the choice of treatment plan.4、 Endocrine therapy is suitable for most G3 EEC patients,the effect is poor for II ECCC patients.Vimentin may serve as a reference indicator for diagnostic ECCC.P53 may serve as a reference indicator for identifying G3 EEC and ECCC.5、There is a certain misdiagnosis rate and missed diagnosis rate in preoperative segmental curettage,and there is a phenomenon that postoperative pathology is upgraded from preoperative pathology.6、 There was no significant difference between G3 EEC and ECCC of 5 years PFS and 5 years OS,which was slightly lower than ECCC.We should pay attention to the diagnosis and treatment of G3 EEC in the course of clinical diagnosis and treatment,and refer to the ECCC plan.7、Cervical interstitial infiltration may indicate a relatively poor prognosis when judging G3 EEC prognosis.Ascites cytologic positive may indicate a relatively poor prognosis when judging ECCC prognosis.When the pathological stage of G3 EEC and ECCC surgery is stage III-IV(late stage),the prognosis is poor. |
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