| Objective: To compare the clinicopathologic features,treatment methods and prognosis of different histopathological types of special types of endometrial carcinoma,and to estimate risk factors and adjuvant therapy that affect the prognosis.Methods: The clinical data and follow-up outcomes of 135 cases of special types of endometrial carcinoma who were initially surgically treated in the Department of Gynaecology of Affiliated Hospital of Qingdao University during January 2009 to December 2017 were retrospectively analyzed.The differences in the clinicopathologic features,treatment methods and overall survival(OS)of 79 cases of uterine serous carcinoma(USC),15 cases of clear cell carcinoma(CCC),17 cases of carcinosarcoma(CS)and 24 cases of mixed cell adenocarcinoma(MCA)were respectively compared.To analyze the effect of CA125?35U/ml,deep muscle infiltration,lymph vascular space lnvasion(LVSI),FIGO stage,ascitic cytology,uterine adnexa metastasis,pelvic lymph nodes metastasis(PLN),para-aortic lymph nodes metastasis(PALN),greater omentum metastasis and chemoradiotherapy methods on the survival outcome.SPSS 24.0 software was used for statistical analysis.T-test was used for measurement data,Chi square test and Fisher's Exact Test were used for enumeration data.Kaplan-Meier was used to calculate the overall 5-year survival rate(OS).Univariate and multivariate Logistic regression analysis were used to estimate risk factors of the prognosis.The significance level for all analysis was set at 0.05.Results: 1.There were statistically significant differences in age ?60 years,menopause,preoperative pathological diagnosis rate,tumor size(?2cm),pelvic lymph node metastasis,greater omentum metastasis and greater omentum resection(P<0.05).2.The overall 5-year survival rate(OS)of USC,CCC,CS and MCA patients were 63.1%,79.4%,37.6% and 87.5%,there were statistically significant differences between different types(P<0.05);the prognosis of patients in USC,CCC and MCA group was singly significantly better than that in CS group(P<0.05);the prognosis of patients in MCA group was significantly better than that in USC group(P<0.05);however,there was no statistically significant difference in the prognosis between USC and CCC group,as well as between CCC and MCA group(P>0.05).3.There was no statistically significant difference in 5-year overall survival rate(OS)between the laparotomy and laparoscopic groups(64.95% vs 70.43%,P>0.05).4.The 5-year overall survival rates of stage I patients in the groups of chemotherapy alone,chemotherapy combined with radiotherapy and no treatment were 94.4%,100.0% and 58.1%,there was significant difference between three groups(P<0.05),the prognosis of the first two groups is separately better than no treatment(P<0.05),while difference of prognosis between the first two groups was no significant(P>0.05).5.On Logistic regression univariate analysis,CA125?35U/ml,deep muscle infiltration,LVSI,FIGO stage,ascitic cytology,bilateral uterine adnexa metastasis,pelvic lymph nodes metastasis,para-aortic lymph nodes metastasis and greater omentum metastasis were risk factors influencing the prognosis of special types of endometrial carcinoma(P<0.05).6.On Kaplan-meier survival analysis,the prognosis of CA125?35 U/ml,deep muscle infiltration,LVSI,bilateral uterine adnexa metastasis,pelvic lymph node metastasis,paraaortic lymph node metastasis and greater omentum metastasis was poor.7.On Logistic regression multivariate analysis,FIGO stage(HR2.341,95%CI 1.596~3.434)and para-aortic lymph nodes metastasis(HR1.623,95%CI 1.180~2.233)were independent risk factors of poor prognosis.Conclusions: 1.The special types of endometrial carcinoma(USC?CCC?CS and MCA)have different clinicopathologic features and prognosis.2.FIGO stage and para-aortic lymph nodes metastasis were independent risk factors of poor prognosis.3.For patients with independent risk factors,thorough surgical staging and personalized adjuvant chemoradiotherapy should be emphasized clinically. |
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