Analysis Of The Prognostic Factors Of Endometrial Carcinoma

Objective:We study the clinical and pathological data of endometrial carcinoma to investigate the prognostic factors of endometrial carcinoma and the correlationship.Methods:The clinicopathologic and surgical records of 298 patients who were diagnosed with endometrial carcinoma from January 2003 to December 2007 in Qilu Hospital of Shandong University were retrospectively reviewed. The inclusion criteria were as follows:(1) All patient must have received their initial treatments in Qilu Hospital of Shandong University;Before the surgery, none received the preoperative chemotherapy, radiation therapy, hormone therapy or other anti-tumor therapy. (2)The pathology specimens of the patients must have been confirmed to be endometrial cancer. Of the 298 patients,the median age is 54 years old; 171 cases of premenopausal 127 patients with postmenopausal. Of all patients,267 patients had endometrial adenocarcinoma including 147cases of G1,87cases of G2,33cases of G3, 31 patients had specific endometrial carcinoma incluing 16 cases of serous papillary carcinoma,14 cases of clear-cell carcinoma,1 case of squamous-cell carcinoma.185 patients had been treated with adjuvant therapy after sugery.134 patients had high risk fators,of which 55 cases was in surgic stage I.39 patients underwent total hysterectomy (TH) and bilateral salpingo-oophorectomy(BSO),138 patients underwentTH, BSO and pelvic lymphadenectomy,121 patients undewent TH, BSO, pelvic lymphadenectomy and para-aortic lymph node sampling.84patients with stage I underwent total hysterectomy(TH), and 135patients underwent hysterectomy of PiverⅡ. Statistical were done with SPSS(version 17.0). Survival rates were estimated by Kaplan-Meier analysis.The survival curves were compared by Log-Rank test. Cox regression analysis was used to select the risk fators for prognosis. The relationship between the prognosic fators was evaluated by Logistic regression.Correlation of variables was assessed with X2 test. We regarded p values of less than 0.05 to be significant.Results:(1)The 3-year and 5-year overall survival rate of the patients with endometrial carcinoma was 90.3%and 78.4%respectivly. The 3-year overall survival rate of patients with I-IV stage was 94.5%,95.0%,87.0%and33.0%respectivly. The 5-year overall survival rate of patients with I-IV stage was 87.2%,69.2%,50% and25% respectivly. (2) Univariate analysis showed that:myometrial invasion, histological type,pathological grade,surgical-pathologic stage, surgic type, and lymph node metastasis was prognosis factors of endometrial cancer.Poor tumor differentiation,high stage of. surgical-pathologic,specific types and the range of surgery was confirmed to be prognostic factors of endometrial carcinoma independently. (3) Logistic regression confirmed that deep myometrial invasion, serosal or adnexa involved,were risk factors for lymph node metastasis. (4) There was no significant difference between TH group and Piver II group of endometrial carcinoma with low-risk of early stage (P>0.05). But the overall survival in TH group was significantly longer than in PiverⅡgroup of endometrial carcinoma with high-risk of early stage (P<0.05). For all patients with high-risk, the overall survival of patients with adjuvant therapy was significantly longer than those without adjuvant therapy(P<0.05), but no significant differences were recorded between radiotherapy groups and chemotherapy groups (P>0.05). The significant differences were also recorded in patients with low-risk of early stage (P<0.05),but no significant differences were recorded between radiotherapy groups and chemotherapy groups (P >0.05). (5)30 patients had lymph node metastasis and the total metastastic rate was 36/259 (13.90%). Pelvic lymph node metastasis was demonstrated in 30 patients and the metastastic rate was 30/259 (11.58%). And para-aortic lymph node metastasis was demonstrated in 6 patients and the metastastic rate was 6/121 (4.96%). Of the patients with lymph node metastasis,2 had para-aortic lymph node metastasis alone, and the metastastic rate was 2/121(1.65%). Of the patients with pelvic lymph node metastasis,13patients underwent para-aortic lymph node sampling, and 4 patients had para-aortic lymph node metastasis, the metastastic rate was 4/13(30.77%). When the depth of myometrial invasion<l/2, the metastastic rate of patients with G1(0.93%) or G2(5.71%) was significantly lower than 35.29%of G3. There was no significant differences between G1 and G2(P1-2>0.05). When the depth of myometrial invasion》1/2, the metastastic rate of G1, G2, G3 was 13.33%,36.36%,50%, and no significant differences were recorded between them (P>0.05)Conclusion:(1)The 3-year and 5-year overall survival rate of the patients with endometrial carcinoma was 90.3%and 78.4%respectivly. (2) Poor tumor differentiation,high stage of surgical-pathologic,specific types and the range of surgery was confirmed to be prognostic factors of endometrial carcinoma independently. We should take systematic assessment preoperativly and intraoperativly. The status of lymph node take an important part in the assessment,and deep myometrial invasion, serosal or adnexa involved,were risk factors for lymph node metastasis. (3)For patients with low-risk of early stage,the outcomes cannot the significantly improved by the expansion of hysterectomy. But for patients with high-risk of early stage, the expansion of hysterectomy will help to improve the overall suevival, and the dissection can also help to prolong the survival time. (4)For all patients with high-risk, the overall survival of patients with adjuvant therapy was significantly longer than those without adjuvant therapy,but no significant differences were recorded between radiotherapy groups and chemotherapy groups. The significant differences were also recorded in patients with low-risk of early stage, but no significant differences were recorded between radiotherapy groups and chemotherapy groups.