| CHAPTER 1 CLINICAL ANALYSIS OF RISK FACTORS FOR POSTOPERATIVE RECURRENCE OF ENDOMETRIAL CANCERBackground: Endometrial cancer is one of the most common gynecological malignant tumors,which seriously threatens women’s health.According to the Cancer Statistics 2018,the number of women with endometrial cancer is expected to increase by 63,230,ranking fourth in the incidence of female malignant tumors.Endometrial cancer is estimated to have 11,350 deaths in2018,which ranks sixth among malignant tumors and second among female reproductive tract malignant tumors,with an increasing trend year by year.How to effectively improve the prognosis and reduce the death of EC patients has always been an important direction of scholars’ exploration and research.With the development of clinical studies and molecular biology,more new potential factors have been found to be associated with the recurrence of endometrial cancer.In China,it is controversial whether new potential risk factors related to EC can be used as factors affecting the postoperative recurrence rate of patients,although their influence on the prognosis of EC patients is significant,which is worth further exploration and dialectic.Objective: To investigate the influence of clinical related factors on postoperative recurrence of endometrial cancer.Methods: The clinical data of 209 cases of endometrial cancer from January 2003 to December 2016 in Tumor Hospital Affiliated to Guangxi Medical University were retrospectively analyzed.According to the recurrence situation,199 cases were divided into two groups(84 cases in recurrence group and 115 cases in non-recurrence group).Age,BMI,climacteric status,pathological types,FIGO stage,histopathology,tumor size,myometrial invasion,LVSI,LNM,ER,PR,P53,Ki-67,CK7,Vimentin,operation mode and the extent of lymphadenectomy were analyzed for the risk factors for recurrence and prognostic factors for PFS and OS of endometrial carcinoma.Results:(1)Analysis of risk factors for recurrence of endometrial carcinoma showed that age(≥55 years old),postmenopause,histopathology,tumor size,LNM(+),ER(-),PR(-),P53 overexpression,Ki-67(+),Vimentin(-),operation mode and the extent of lymphadenectomy were risk factors for recurrence of endometrial carcinoma.Such factors as histopathology,tumor size,LNM(+)and the extent of lymphadenectomy were the independent risk factors for postoperative recurrence of endometrial carcinoma.(2)Analysis of prognostic factors for PFS of endometrial carcinoma showed that age(≥ 55 years old),histopathology,LNM(+)and the extent of lymphadenectomy were prognostic factors for PFS of endometrial carcinoma.Such factors as histopathology,LNM(+)and the extent of lymphadenectomy were the independent prognostic factors for PFS of endometrial carcinoma.(3)Analysis of prognostic factors for OS of endometrial carcinoma showed that age(≥55 years old),postmenopause,histopathology,tumor size,LNM(+),Ki-67(+),operation mode and the extent of lymphadenectomy were prognostic factors for OS of endometrial carcinoma.Such factors as histopathology,LNM(+),operation mode and the extent of lymphadenectomy were the independent prognosticfactors for OS of endometrial carcinoma.Conclusions:(1)Evaluating the factors of patients with endometrial cancer after primary surgery,such as age,climacteric status,histopathology,tumor size,LNM,ER,PR,P53,Ki-67,Vimentin,surgical methods and the extent of lymphadenectomy,is of great significance to reduce the recurrence rate.(2)Age,histopathology and LNM are important prognostic factors of progression-free survival(PFS)in patients with endometrial cancer.(3)Age,menopause,histopathology,tumor size,LNM and Ki-67 are important prognostic factors of the overall survival(OS)of endometrial cancer patients.Age,histopathology and LNM are independent prognostic factors of OS.(4)Laparoscopic staging surgery can significantly reduce the recurrence rate and improve the prognosis of endometrial cancer patients.CHAPTER 2 META-ANALYSIS OF RISK FACTORS FOR POSTOPERATIVE RECURRENCE OF ENDOMETRIAL CANCERBackground: Endometrial cancer is one of the most common gynecological malignant tumors,which seriously threatens women’s health.According to the Cancer Statistics 2018,the number of women with endometrial cancer is expected to increase by 63,230,ranking fourth in the incidence of female malignant tumors.Endometrial cancer is estimated to have 11,350 deaths in 2018,which ranks sixth among malignant tumors and second among female reproductive tract malignant tumors,with an increasing trend year by year.How to effectively improve the prognosis and reduce the death of EC patients has always been an important direction of scholars’ exploration and research.With the development of clinical studies and molecular biology,more new potential factors have been found to be associated with the recurrence of endometrial cancer.In China,it is controversial whether new potential risk factors related to EC can be used as factors affecting the postoperative recurrence rate of patients,although their influence on the prognosis of EC patients is significant,which is worth further exploration and dialectic.Objective: A systematic review and meta-analysis of high risk factors for recurrence of endometrial cancer patients after surgery provides a basis forclinical practice.According to the Cancer Statistics 2018,the number of women with endometrial cancer is expected to increase by 63,230,ranking fourth in the incidence of female malignant tumors.Endometrial cancer is estimated to have11,350 deaths,which ranks sixth among malignant tumors and second among female reproductive tract malignant tumors,and it is increasing year by year.Methods: Search for literature and literature references related to the risk factors of postoperative recurrence of endometrial cancer in patients treated by primary surgical treatment on the databases such as CNKI,VIP,Wan Fang,Pubmed,EMBase,the Cochrane Library and professional journals.Cohort studies and randomized controlled studies from the date of the database establishment to January 2019 were included.In the retrieval process,2evaluators independently and strictly abide by the inclusion criteria and exclusion criteria to screen literature and extract data.The quality of the obtained literature was evaluated by the Newcastle-Ottawa Scale standard.All data were meta-analyzed using Revman5.3 and SPSS.Results: There were 38 studies and 16,858 samples included of which results showed that: 1.the postoperative recurrence rate of age>50 group was higher than that of <50 group(P < 0.05);2.the postoperative recurrence rate of the FIGO II group was higher than that of the FIGO I group(P < 0.05),the postoperative recurrence rate of the FIGO III group was higher than that of the FIGO I group(P < 0.05),the postoperative recurrence rate of the FIGO IV group was higher than that of the FIGO I group(P < 0.05);3.the postoperative recurrence rate of the histology G3 group was higher than that of the histology G1 group(P < 0.05);4.the postoperative recurrence rate in the positive LVSI group was higher than that in the negative LVSI group(P < 0.05);5.the postoperative recurrence rate of myometrial invasion > 1/2 group was higherthan that of myometrial invasion < 1/2 group(P < 0.05);6.the postoperative recurrence rate in the tumor size > 2cm group was higher than that in the tumor size < 2cm group(P < 0.05);7.the postoperative recurrence rate of the positive ascites cytology group was higher than that of the negative group(P <0.05);8.the postoperative recurrence rate of the positive lymph node metastasis group was higher than that of the negative group(P < 0.05);9.the postoperative recurrence rate of other pathological groups was higher than that of endometrioid adenocarcinoma group(P < 0.05);10.the postoperative recurrence rate of the ER negative group was higher than that of the ER positive group(P <0.05);11.the postoperative recurrence rate of the PR negative group was higher than that of the PR positive group(P < 0.05);12.the postoperative recurrence rate of postmenopausal group was higher than that of non-menopausal group(P <0.05);13.the postoperative recurrence rate of pelvic lymph node dissection alone was higher than that of pelvic lymph node + para-aortic lymph node dissection group(P < 0.05);14.surgical methods(laparotomy vs.laparoscopic surgery),body mass index,PTEN and P53 had no statistically significant effect on the postoperative recurrence rate of EC patients(P > 0.05).Conclusions: Age > 50,FIGO stage,histological grade,LVSI positive,myometrial invasion depth > 1/2,tumor size > 2cm,ascites cytology positive,lymph node metastasis,pathological type,ER negative,PR negative,menopause and para aortic lymph node non-dissection were the risk factors which had a significant infulence on the recurrence rate of EC patients. |
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