384 Example Intrauterine Membrane Cancer Clinical Analysis

Objectives:To analyze retrospectively all the patients of endometrial carcinoma (EC) treated at Peking Union medical college hospital from1984—2003, a systematic search of MEDLINE database (2000to March2011)was conducted, the progress in the field of diagnosis and treatment of EC was discussed。Methods:A total of384EC patients treated during1984—2003were analyzed(314endometrioid adenocarcinoma EAC and70non endometriod adenocarcinoma non EAC), the clinical characteristics, management, outcome of a]1the patients were retrospectively analyzed. And the analysis of prognostic factors was performed by SPSS13.0, literatures were reviewed, and the progress of EC in the field of diagnosis and treatment was discussed. Results:The median age of the total384patients was57years. Compared with Non EAC patients, the median age, gravidity and parity of EAC patients are lower. The incidence of non EAC increased significantly in postmenopausal patients. Most of the patients presented with vaginal bleeding (90%),93%patients presented with thickening of endometrium under pelvic ultrasound.Endometrial lesion were diagnosed by D&C in347patients (90.4%),15patients was diagnosed by hysteroscopy with D&C.372patients were treated with surgery (96.6%),326with open surgery while46patients with laparoscopic surgery, including hysterectomy and bilateral salpingo-oophorectomy, comprehensive staging operation (hysterectomy, bilateral salpingo-oophorectomy and pelvic¶aortic lymphadenectomy) and cytoreductive operation Other12medical inoperable patients accepted radiotherapy or hormonal therapy.311patients were early stage(83%), including284stage â…  and27stage â…¡ patients.63patients were advanced stage, including53stage â…¢ and10stage â…¥ patients。314cases are EAC(82%), while70cases are non EAC(18%), among the non-EACs,38cases are clear cell carcinoma (9.9%), papillary serous carcinoma22cases (6.2%), adenosquamous carcinoma6cases (1.5%), mucinous adenocarcinoma3cases (0.8%),chorionic carcinoma1case(0.3%). Disease progressed in19patients;45patients recurrenced, the recurrence rate was12%。In the last follow up,316patients were complete remission(CR), among which7cases got CR again after relapse,32patients were alive with disease and24patients were dead of disease,4dead of other disease,8not available. In COX multivariate analysis, age at presentation and stage are risk factors,(P=0.08,<0.001seperately) compared with variables above, tumor histology and tumor grades were not significant factors in predicting disease outcome.Conclusions:The mean age of EC patients treated in Peking Union Medical College Hospital is lower and the proportion of clear cell carcinoma in non-EAC is more compared with literatures reported. Patients presenting with postmenopausal bleeding can be initially evaluated with pelvic ultrasound and fractional D&C(dilation and curettage) can be done in suspicious patients. Compared with simple D&C, diagnostic hysteroscopy with directed biopsy is more sensitive to identify endometrial lesion.Laparoscopic staging surgery is recommended, low risk patients can be treated with hysterectomy, bilateral salpingo-oophorectomy, and comprehensive pelvic lymphatic detection. Fertility-sparing treatment is an option for stage Ia or Ib patients who is very young and eager to spare fertility. Radiotherapy, chemotherapy and hormonal therapy were suggested for high-risk,advanced and recurrent patients. Within2-3years since diagnosis of primary tumor, intensive follow up is recommended.