早期子宫内膜癌保留生育功能治疗后复发的诊治

doi:10.6040/j.issn.1671-7554.0.2018.229

摘要/Abstract

摘要： 目的分析经保留生育功能治疗完全缓解(CR)后的早期子宫内膜癌(EC)患者,复发后再次治疗的效果及预后情况。方法回顾性分析2004年1月至2017年9月北京协和医院妇产科36例经高效孕激素或促性腺激素释放激素类似物(GnRH-a)治疗达到CR后复发患者的临床资料,其中25例行再次保留生育功能治疗,11例直接手术治疗,分析其疗效及预后。结果 36例患者中,复发后病理22例为EC,14例为不典型增生(AH)或子宫内膜上皮内瘤变(EIN)。患者在初次保守治疗结束后6~55个月复发,中位复发时间17个月。25例符合标准行再次保留生育功能治疗患者中,21例可评估疗效,其中16例达到CR(16/21,76.2%),显著低于初次治疗缓解率(93.6%)(P=0.016)。依照复发病理,AH/EIN患者CR率为90.9%(10/11),高于EC组的60.0%(6/10),但差异无统计学意义(P=0.149)。16例CR患者中,2例受孕并成功分娩,2例复发。5例保守治疗无效行手术治疗的患者中,术后分期ⅢA期2例,ⅠA期3例;3例术后需要辅助放疗+/-化疗,随诊均无复发。11例直接行手术治疗的患者中,8例于我院行手术治疗,术后分期为ⅢC₂期1例、ⅠA期5例、EIN及AH1~2 2例,随诊无复发;3例失访。结论对于行保留生育功能治疗后复发的EC患者,再次保守治疗的有效率低于初次治疗的有效率,但仍可取得较好疗效,且患者有完成生育的可能。

关键词: 子宫内膜癌, 子宫内膜不典型增生, 子宫内膜上皮内瘤变, 复发, 保留生育功能治疗

Abstract: Objective To evaluate the efficacy and prognosis of secondary treatment on patients with recurrent endometrial cancer(EC)after complete remission(CR)for primary fertility-preserving therapy. Methods Thirty-six cases with recurrent EC after CR for primary fertility-preserving therapy from January 2004 to September 2017 at Peking Union Medical College Hospital were retrospectively analyzed. Twenty-five patients received the second course of fertility-preserving treatment and 11 patients received hysterectomy. The clinical efficacy and prognosis of the retreatment were also analyzed. Results Of the 36 recurrent patients with a median disease free interval period of 17 months(ranged 6 to 55 months), 22 were pathologically diagnosed as EC, and 14 were pathologically diagnosed as atypical hyperplasia(AH)or endometrial intraepithelial neoplasia(EIN). Twenty-five patients met the criteria of fertility-preserving therapy and repeated hormonal therapy, and 21 patients were evaluable for efficacy, among whom, 16 patients achieved CR(16/21, 76.2%)with the lower CR rate than that of primary fertility-preserving treatment(93.6%), P= 山东大学学报 (医学版)56卷5期 -俞梅,等.早期子宫内膜癌保留生育功能治疗后复发的诊治 \=-0.016. According to the pathologic diagnosis of recurrence, the CR rate in AH/EIN patients was higher than that in EC patients while without a statistical difference(90.9% vs 60.0%, P=0.149). Among 16 patients achieved CR, 2 got pregnant and delivered successfully, while 2 relapsed again. Five cases failed to retreatment of fertility-preserving therapy then took the surgery; two of them were of stage ⅢA and three of stage ⅠA; three of them needed adjuvant radiotherapy +/- chemotherapy postoperatively, and no recurrence was observed during the follow-up. Eleven patients received surgery, eight of whom were treated in our hospital with one of stage ⅢC₂, five of stage ⅠA, two diagnosed as EIN or AH1-2, and no recurrence was observed during the follow-up. Other three patients were lost to follow-up. Conclusion For patients with recurrent EC after primary fertility-preserving treatment, CR rate of retreatment was lower than that of primary treatment, while still attain a promising response and have possibilities of successful pregnancies.

Key words: Endometrial cancer, Atypical endometrial hyperplasia, Endometrial intraepithelial neoplasia, Recurrence, Fertility-preserving therapy

中图分类号:

R711.74

俞梅,杨佳欣,曹冬焱,王遥,沈铿. 早期子宫内膜癌保留生育功能治疗后复发的诊治[J]. 山东大学学报 (医学版), 2018, 56(5): 23-29.

YU Mei, YANG Jiaxin, CAO Dongyan, WANG Yao, SHEN Keng. Diagnosis and management in patients with recurrent stage I endometrial cancer after primary fertility-preserving treatment[J]. Journal of Shandong University (Health Sciences), 2018, 56(5): 23-29.

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