The Clinical Research Of 192 Patients With Endometrial Cancer

Objective: To summarize and analysis the clinicopathologic data of patients with endomential carcinoma who accepted treatment in China-Japan Union hospital of Jilin University for the last 15 years.To explore onset's new trendency, changs of clinicopathologic characteristics, and to aim to find a more useful, reasonable means of prevention and treatment.Methods: A retrospective study is carried out on clinicopathologic data of 192 patients with endomential cancer who accepted treatment in China-Japan Union hospital of Jilin University from Jan.1992 to Dec.2006.The general conditions,medical history, physical signs, auxiliary examinations, pathological information from these patients were all collected into a database and divided into groups according to the period and age of disease onset, and draw the tables. The data were examined with statistical analysis using SPSS 13.0 software.Result:1. The onset feature of endomential carcer The mean age of the 192 patients with endomential cancer gradually decreased over the past 15 years, take on young tendency obviously. From 53.44±8.00 years old in 2002- 2006 to 50.92±8.55 years old in 1992-1996, The mean ages in different five years examined with statistical analysis have significant differences.Furthermore, the ratios of early stage cancer (stageⅠ) steadily increased, the ratio of early stage increased from 69.7% in 1992-1996 to 72.0%in 2002- 2006. The ratios of poorly differentiated increase from 12.1% in 1992- 1996 to 35.0% in 2002-2006, and have significant statistical differences (p<0.05).It is said that the age of menarche of patients is ahead,the age of menopause is delayed,the ratio of pregnancy and delivery is decreased. In our research, themean age of menarche is earlier than before,the ratios of menarche of patients who are≤12 years old is increased from 0% in 1992-1997 to 3.0% in 2002- 2006,the ratio of menopause of patients who are≥52 years old is 18.0% in 2002- 2006, surpass 15.2%in 1992 -1997. the ratio of pregnancy and delivery is decreased,but the ratio of different five years examined with statistical analysis have no significant statistical differences(p>0.05).2. The young tendency of endomential cancer and its characteristics The mean age of endomential cancer patients gradually decreased over the past 15 years, take on young tendency,from 53.44±8.00 years old in 2002-2006 to 50.92±8.55 years old in 1992-1996.The rate of young patient(s≤45岁)rose from 6.1 % in 1992-1996 to 26.0 % in 2002-2006, increased 4 times, corresponding the ratio of old patients decrease,examined with statistical analysis have significant differences.During the young patients with endomential cancer,the ratio of patients with menstrual disorder, primarily and scendary infertility is higher. In our study, the ratio of young patients (≤45 years old ) with primarily infertility is 10 times than older patients (>45 years old). The ratio of primarily infertility,examined with statistical analysis have significant differences(p<0.05).Histological differentiation of young patients is better,the ratio of myometrial invasion is fewer, the depth of myometrial invasion is more superficial, By examining with statistical analysis have significant differences(p<0.05).The pathologic type is also better in young patients than older patients,but have no significant statistical differences(p>0.05).3. Preservation of reproductive endocrine functionYoung patients whose stage is earlier, differentiation is better, have good follow-up condition and capability,no medication taboo, intensitive fertilitity desire, could take progestogen to preserve fertility ability at close observation and follow-up visit. There are many documents of internal and overseas that some of endomential cancer patients whose stage is earlier could bear successfully after preserving fertility treatment with progestin.we haven't yet employed that fertility -preserving treatment with progestin.In our study,a few of patients who is≤35 years old has been preserved either of ovaries, and treated with progestin after operation, it seems that there are no significant poor effects. Thus,in our opinion, if ovaries'appearance of early stage patients who is young and no high risk factors is normal,throughing biopsying to confirm no microscope metastasis,preserving ovaries may be safe. But,the amount of patients are limited, moreover,it is just a retrospective research,this conclusion should be to confirm using a prospective, random, control reseach, that couldn't be a conventional therapeutic tool.Expectant treatment with progestion may be risk and delay state of an illness. We must communicate thoroughly with patients and their family, illustrate advantages and disadvantages, and choose that treatment method during their permissions. But, that still needs close observation during the course of treatment and post-treatment.4. Differention between clinical stage and surgical-pathologic stageThere are some differetion between surgical-pathologic stage and clinical stage. In our reaearch, The ratio of relative accuracy at pro-operation and post- operation which clinical stage is stage I is 11.1%, the ratio of relative accuracy of stageⅡis 70.3%,stage III is 10.0%,StageⅣis 0%.The ratio of relative accuracy of stageⅡis higher.In order to decrease the ratio of relative accuracy,examine carefully before operation ,elevate the accuracy rating of stage as far as possible,so as to institute operational and other treatment planspreferably.Conclusion:1. The patients with endomential cancer are younger and younger, the ratio of early stage and poorly differentiated increase.premenopause women who had menstrual disorder and clinical manifestation correlating with it ,should exclude the possibility of endomential cancer in the first place. To patients with high-risk factors ( high blood pressure, diabetes, fatness, infertility etc ).It is suggested that should take regular gynecologic examination,ultrasonic inspection, hysteroscopy and diagnostic curettage if it is necessary,which could elevate earlier diagnosis ratio.2. The young patients have noticeable different clinicopathologic feature: earlier clinical stage, well-differentiated, superficial myometrial invasion and so on , who have better prognosis.the patients'prognosis will be improved through being given reasonable and available hormone therapy, furthermore, that the preservation of reproductive endocrine function should be considered.3. To examine carefully, and determine clinicopathologic stage, could improve diagnostic accuracy;to diagnose as early as possible,systematical and standard operation, effective adjunctive therapy after operation is very important.