The Clinical Research Of 455 Patients With Endometrial Cancer

Objective: To summarize and analysis the clinic and pathologic data of patients with endometrial carcinoma who accepted treatment in the department of gynecology of the Second Hospital of Jilin University for the last 5 years,explore onset's new tendency and relationship of some prognostic factors, to aim to make contribution to early prevention,diagnosis and treatment of endometrial cancer , improve the rate of survival. Methods: A retrospective study is carried out on clinic and pathologic data of 455 patients with endometrial cancer who accepted treatment in the department of gynecology of the Second hospital of Jilin University from Jan.2005 to Dec.2009. The general conditions, medical history, auxiliary examinations, treatment,pathological information from these patients were all collected into a database and divided into groups according to the period,menopausal status,menopausal period,pathological type and histological grade. These collected data were analyzed by descriptive statistics using excel software .The data were examined with statistical analysis using SPSS 17.0 software. Measurement data were expressed in the form of Mean±standard deviation(X士S),compared with t- test.Enum- eration data were expressed in the form of ratio,compared withχ2 test. A statistically significant difference was indicated by P<0.05.Results:1. There were 69 cases in 2005, increased to 125 cases in 2009. the proportion of patients in cities have increased gradually(P<0.01) .2. The mean of menopausal age is 53.27±8.98 years old. The people aged 54 to 56 were 106 cases, accounted for 23.30% of all the cases.3. There are 293 cases in menopausal (64.40%). The mean of menopausal age is 49.68±3.89 years old. There are 162 cases in premenopausal (35.60%).4. The ratios of patients who suffered from hypertension, diabetes, obesity and infertility and(or) sterility have increased gradually (P<0.05or P<0.01).5. There were 3 missed cases in this study, which patients were premenopausal, characterized by abnormal vagina bleeding and preoperative diagnosis were myoma of uterus. There was 1 misdiagnosed case, preoperative diagnosis were cervical cancer diagnosed by cervix biopsy. Missed cases and misdiagnosed case both were diagnosed by rapid intraoperative pathological. 6. Endometrioid adenocarcinomas are 410 cases , accounting for 90.11% in this study. Nonendometrioid tumors are 45 cases, accounting for 9.89% in this study.⑴And t- test shows remarkably difference (P<0.01), the age of patients who suffered from nonendometrioid tumors is higher than patients who suffered from endometrioid tumors.⑵The ratios of patients who suffered from nonendometrioid tumors is 12.97% in Group Postmenopausal, and 4.32% in Group Premenopausal. And there are significant differences (P<0.01) in two groups.⑶There are significant differences (P<0.05) between Group Nonendometrioid Tumors and Group Endometrioid Tumors about histological grade. This study shows that histological grade significantly associated with pathologic type of endometrial carcinoma. The ratios of well differentiated endometrioid tumors is higher than moderately-poorly differentiated, the ratios of moderately-poorly nonendometrioid tumors is higher than well differentiated.⑷There are significant differences (P<0.01) between Group Nonendometrioid Tumors and Endometrioid Tumors about surgical - pathologic stage.This study shows that the ratios which are surgical - pathologic stageⅠandⅡis higher than which are stageⅢandⅣof endometrioid tumors, the ratios which are surgical - pathologic stageⅢa ndⅢis higher than which are stageⅠa ndⅡo f nonendometrioid tumors.⑸There are significant differences (P<0.01) between Group Nonendometrioid Tumors and Endometrioid Tumors about myometrial invasion. This study shows that the ratios which are no and superficial myometrial invasion is higher than which are deep myometrial invasion of endometrioid tumors. And the ratios which are deep myometrial invasion is higher than which are no and superficial myometrial invasion of nonendometrioid tumors.⑹There are significant differences (P<0.01) between Group Nonendometrioid Tumors and Endometrioid Tumors about expression of estrogen and progestrogen receptor. This study shows that the ratios, which are ER (+) and PR (+), is higher than which are ER (-) and PR (-) of endometrioid tumors. And the ratios, which are ER (-) and PR (-), is higher than which are ER (+) and PR (+) of nonendometrioid tumors.7.⑴There are significant differences (P<0.01) between the constituent ratios of histological grading in Group Premenopausal and Group Postmenopausal. This study shows that the ratios, which are well differentiated endometrial cancer, are higher than which are moderately or poorly differentiated in Group Premenopausal. And the ratios, which are moderately- poorly differentiated endometrial cancer, is higher than which are well differentiated in Group Postmenopausal.⑵The constituent ratios of well differentiated endometrial cancer in parents whose menopausal period is≤5 or 6~10 years is higher than whose menopausal period is 11~15years. The constituent ratios of moderately or poorly differentiated endometrial cancer in parents whose menopausal period is 11~15 years is higher than whose menopausal period is≤5 ot 6~10years (P<0.01).8.The ratios of patients who are surgical - pathologic stageⅡhave increased g- radually(P<0.05).9. There are significant differences (P<0.05 or P<0.01) between Group G1 and Group G2/G3 about myometrial invasion. This study shows that the ratioswhich are no and superficial myometrial invasion is higher than which are deep myometrial invasion of low-grade endometrioid tumors. The ratios which are deep myometrial invasion is higher than which are no and superficial myometrial invasion of moderately or poorly differentiated endometrioid tumors.10. There are significant differences (P<0.01) between GroupⅠ/Ⅱand GroupⅢ/Ⅲabout estrogen /progesteronereceptor (ER/PR) expressions. The constituent ratio of ER (+) and PR (+) is higher than ER (-) and PR (-) of patients who are surgical - pathologic stageⅠandⅡ.⑵There are significant differences (P<0.01) between Group G1and Group G2 /G3 about estrogen /progesteronereceptor (ER/PR) expressions. The constituent ratios of ER (-) and PR (-) is higher than ER (+) and PR (+) in moderately- poorly differentiated endometrial cancer.11.⑴There are 442 cases which have taken laparotomy surgery, accounted for 97.14% of all the cases.⑵There are 6 cases which have taken laparoscopic surgery, accounted for 1.32% of all the cases.⑶There are 7 cases which have taken cloudy surgery, accounted for 1.54% of all the cases.12. There are 333 cases which have taken pelvic lymphadenectomy, 18 cases with lymph node metastasis. There are 22 cases which have taken pelvic lymphadenectomy and paraaortic lymphadenectomy, 1 case with lymph node metastasis which is serous adenocarcinoma. The metastasis of pelvic lymph node occurs in 19 cases, 7 cases are endometrioid adenocarcinomas,12 cases are nonendometrioid tumors. Conclusion:1. The number of cases has been on the rise in the past 5 years.the cases and proportion of towns has increased annually.2. The constituent ratio of premenopausal patient is higher than earlier domestic census information, and peak of age distribution has moved forward. The patients with endometrial cancer are younger and younger.3.The constituent ratios of hypertension,obesity,diabetes,infertility and sterility has been on rise. To women with high-risk factors, it is suggested that should take regular gynecologic examination, which could elevate earlier diagnosis ratio. It is necessary to make active treatment on original diseases to early prevention of endometrial cancer.4. Most of missed diagnosis and misdiagnosis cases come from premenopausal patients.To premenopausal women who develope abnormal vagina bleeding should be alert to endometrial cancer and take gynecologic examination to make the diagnoses.5.⑴Compared with nonendometrioid tumors, the patients who suffered from endometrioid adenocarcinomas were much younger. The ratios of patients who suffered from nonendometrioid tumors is higher than who suffered from endometrioid adenocarcinomas in Group Postmenopausal;⑵Most of endometrioid adenocarcinomas are low-grade, surgical - pathologic stageⅠandⅡ, ER (+) and PR (+);most of nonendometrioid tumors aremoderately and poorly differentiated, surgical - pathologic stageⅢandⅢ, ER (-) and PR (-).There is higher incidence of lymph node metastasis and deep stromal invasion in nonendometrioid tumors than endometrioid adenocarcinomas.Promoting awareness of surgical-pathologic stage,grading of tumor,myometrial invasion and estrogen/progestero- nereceptor(ER/PR) expressions of nonendometrioid tumors, is very important for clin- ics in anticipatingthe prognosis and treatment.6. There was a negative relation between myometrial invasion and grading of tumor. Most of low-grade endometrial cancer is no and superficial myometrial invasion, most of moderately or poorly differentiated endometrioid tumors is deep myometrial invasion.7. Most of premenopausal patients suffered from low-grade endometrial cancer.Most of postmenopausal patients suffered from moderately or poorly differentiated endomet- rial cancer. The constituent ratios of low- grade endometrial cancer are higher in patients whose menopausal period≤5 years or 6~10 years than in patients whose menopausal period≥11years and≤15years.It is suggest that popularise prevention of endometrial carcinoma to early detection and treatment. 8. The ratios of patients who are surgical - pathologic stageⅠhave descended year by year and the ratios of patients who are surgical - pathologic stageⅡhave ascended year by year in the department of gynecology of the Second Hospital of Jilin University for the last 5 years.9. The positive of ER and PR is higher in low- grade endometrial cancer than moderately or poorly differentiated. The positive of ER and PR is higher in surgical - pathologic stageⅠorⅡendometrial cancer thanⅢorⅣ. There need to perfect further the detection of expression of ER and PR, to estimate prognosis and conduct the adjunct the- rapy after surgery.