| Objective:In this study,we retrospectively analyzed the data of patients with endometrial carcinoma(EC)to explore the high risk factors and related factors of survival and prognosis of EC patients,so as to provide reference for clinicians in the screening,diagnosis,treatment and prognosis of EC.Methods:Data of all patients diagnosed with EC in Gansu Provincial Hospital in 2012.12-2016.1 were screened.The basic clinical data,pathological type,surgical methods and postoperative adjuvant treatment of the patients were described,the clinical data and pathological type of EC were compared in groups.The five-year overall survival(OS)of the patients was calculated,and risk factors affecting EC survival prognosis were analyzed.Patients with EC were further divided into groups according to whether they had lymph node metastasis,and analysed the risk factors of EC lymph node metastasis.Result:1.128 EC patients were enrolled in this study,with a mean age of 53.42±9.31years at admission,44 patients(34.4%)<50 years,and 84 patients(65.6%)≥50 years.105 cases(82.0%)with BMI<28kg/m~2,23 cases(18.0%)with BMI≥28kg/m~2.Sixty-one patients(47.7%)had postmenopausal onset,with a mean age at menopause of 50.20±3.07 years.There were 5 cases(3.9%)of non-pregnant patients,of which 1 case of infertility caused by polycystic ovary syndrome,57 cases(44.5%)of 1-2 pregnancies,and 66 cases(51.6%)of≥3 pregnancies.123(96.1%)cases of patients presented with irregular vaginal bleeding.Fifteen patients(11.7%)were complicated with DM,and 12of them were diagnosed with T2DM.88 cases(68.8%)received open surgery,and 40cases(31.2%)received laparoscopic surgery.Postoperative treatment included chemotherapy alone in 64 cases(50.0%),radiotherapy combined with chemotherapy in14 cases(10.9%),and adjuvant radiotherapy in 2 cases(1.6%).There were only 48cases(37.5%)with regular follow-up review without postoperative radiotherapy or chemotherapy.2.Forty nine patients(58.3%)with<1/2 myometrial invasion and 35 patients(41.7%)with≥1/2 myometrial invasion in the EC group≥50 years had higher rates of deep myometrial invasion than the former group(P<0.001).In the menopausal group,there were 31 cases(50.8%)of muscular layer infiltration<1/2,and 30 cases(49.2%)of muscular layer infiltration≥1/2.The rate of deep muscular layer infiltration was significantly higher than that of the former group(P<0.001).For EC patients with different pregnancies,there were 39 cases(59.1%)of muscular infiltration<1/2 in the group of≥3 pregnancies,and 27 cases(40.9%)of muscular infiltration≥1/2.The proportion of deep muscular infiltration increased as the number of pregnancies increased(P=0.022).3.The mean OS time of the 128 patients with EC in this study was 67.16±18.16months,and a total of 21 patients developed local or distant metastasis of the tumor and died in 17 cases by the end of follow-up,resulting in a three-year OS rate of 87.1%and a five-year OS rate of 85.9%.The five-year OS rates were 91.2%,88.6%,71.4%,58.3%for stage IA,I B,II and III tumors,respectively.4.Univariate analysis showed that lymph node metastasis(χ2=32.152,Р<0.001)、surgical-pathological staging(χ2=14.586,Р=0.002)、menopausal status(χ2=9.557,Р=0.002)、histological grade(χ2=10.413,Р=0.005)、age(χ2=6.913,Р=0.009)、PR(χ2=5.658,Р=0.017)、pregnancies(χ2=4.727,Р=0.030)、postoperative treatment(χ2=8.653,Р=0.034)、ER(χ2=4.498,Р=0.034)、LVSI(χ2=4.468,Р=0.035)and depth of myometrium invasion(χ2=4.142,Р=0.042)and the correlation between EC five-year OS rate.Age(RR=10.233,P=0.035),histological grade(RR=6.781,P=0.001)and surgery-pathological stage(RR=1.989,P=0.007)were independent prognostic factors for EC prognosis.5.Lymph node positivity was found in 8 of 128 patients with EC,and on univariate analysis,the depth of myometrial invasion(P=0.001),PR(P=0.017),adnexal involvement(P=0.031)and ER(P=0.040)were associated with EC lymphatic metastasis,and logistic regression analysis suggested that PR(OR=0.163,95%CI:0.032-0.816,P=0.027),depth of myometrial invasion(OR=0.063,95%CI:0.007-0.552,P=0.013)was independently associated with EC lymph node metastasis.Conclusions:1.EC patients aged≥50 years,≥3 pregnancies and postmenopausal patients have an increased probability of deep infiltration.2.The 5-year OS rate of EC patients included was 85.9%.Lymph node positivity,surgery pathological stage,menopause status,histological grade,age,pregnancy status,postoperative treatment,PR,ER and LVSI were significant prognostic factors for EC.Advanced age,stage III,and G3 are closely related to poor prognosis in EC.3.The pathological examination of EC patients indicate that the risk of lymph node metastasis is increased when the tumor invades the deep muscle layer and PR is negative. |
PDF Full Text Request