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目的通过对子宫乳头状浆液性癌(UPSC)临床病理特征的分析,探讨合理的治疗方法。方法回顾性研究1994年1月至2006年9月中国医学科学院肿瘤医院收治的29例UPSC。结果29例中,3例单纯放疗,5例外院手术,全面手术分期21例,其中Ⅲ、Ⅳ期患者占81.0%(17/21)。术前诊刮确诊率:47.6%,术后病理纯型占69.2%,混合型占26.9%,息肉型占3.8%,深肌层浸润占45.0%(9/21),腹膜后淋巴结转移率56.3%(9/16),大网膜转移率33.3%(4/12)。92.3%(24/26)的患者术后接受化疗,34.6%(9/26)的患者术后接受化疗+放疗。Ⅲ期、ⅣB期3年总存活率分别为64.8%、53.3%,5年总存活率分别为43.2%、0。单因素分析显示腹膜后淋巴结转移(P=0.014)、术中残存肿瘤(P=0.013)、辅助术后放疗(P=0.021)与预后有关,多因素分析显示仅术中残存肿瘤与预后有关(P=0.042)。结论子宫乳头状浆液性癌恶性程度高,预后差,诊断时晚期病例占大多数,强调手术应行全面的分期和最大限度的减瘤术,术后放疗可改善预后。
Objective To investigate the clinicopathological features of uterine papillary serous carcinoma (UPSC) and explore the reasonable treatment. Methods Retrospective study of 29 cases of UPSC admitted to Tumor Hospital of Chinese Academy of Medical Sciences from January 1994 to September 2006. Results Among the 29 cases, 3 cases were treated with radiotherapy alone and 5 cases were treated by external hospitalization. Among them, 21 cases were completely surgically staged, of which 81.0% (17/21) were patients in stage Ⅲ and Ⅳ. The diagnosis rate of preoperative curettage was 47.6%, postoperative pathology was 69.2%, mixed type was 26.9%, polyp type was 3.8%, deep myometrial invasion was 45.0% (9/21), and the rate of retroperitoneal lymph node metastasis was 56.3 % (9/16), omental transfer rate was 33.3% (4/12). Of the patients, 92.3% (24/26) received postoperative chemotherapy and 34.6% (9/26) received postoperative chemotherapy and radiotherapy. The 3-year total survival rates of stage Ⅲ and ⅣB were 64.8% and 53.3%, respectively. The 5-year overall survival rates were 43.2% and 0. Univariate analysis showed that retroperitoneal lymph node metastasis (P = 0.014), intraoperative residual tumor (P = 0.013) and adjuvant postoperative radiotherapy (P = 0.021) were related to prognosis. Multivariate analysis showed that residual residual tumor only correlated with prognosis P = 0.042). Conclusions Uterine papillary serous carcinoma has a high degree of malignancy and poor prognosis. The majority of cases diagnosed with advanced stage disease emphasize that surgery should be performed in full stage and maximally reduced tumor reduction. Postoperative radiotherapy can improve prognosis.