子宫内膜癌手术预后因素的多因素分析

王敏; 马志红; 史春雪

doi:10.3969/j.issn.1000-8179.2011.06.013

摘要: 目的：分析和评价子宫内膜癌常用临床病理因素（绝经前后、手术病理分期、组织学分级、淋巴结转移、病理类型、术后辅助治疗、肌层浸润深度）和生物学因素（COX-2、 VEGF、 KDR及ER、 PR）对子宫内膜癌手术预后的影响，筛选出对子宫内膜癌手术预后最有显著的影响因素。方法：将可能与子宫内膜癌预后有关的常用临床病理因素和生物学因素进行单因素分析。通过Cox模型对单因素分析筛选出的影响子宫内膜癌预后的因素进行多因素分析。结果： 137例子宫内膜癌患者中，通过随访，共获得确切随访者112例， 5年生存率为83.04%。Ⅰ~Ⅳ期5年生存率分别为89.66%， 80.00%， 53.85%， 0。子宫内膜癌组织中COX-2、VEGF及KDR蛋白的阳性率分别为47.32%、 66.07%及52.68%，且三者表达具有协同性。COX-2、 VEGF、 KDR蛋白阳性患者5年累积生存率分别为75.47%、 78.38%、 72.88%。将这些临床病理因素及生物学因素进行单因素分析，结果手术病理分期、组织学分级、肌层浸润深度、有无淋巴结转移、 COX-2阳性表达、 KDR阳性表达、 ER阳性表达、 PR阳性表达8个因素与预后明显相关（P均><0.05），绝经前后、病理类型、术后辅助治疗、 VEGF阳性表达与预后无关（P均>0.05）。应用Cox模型对单因素分析筛选出的8个有显著意义的因素进行多因素分析表明：肌层浸润深度、手术病理分期、组织学分级是影响子宫内膜癌手术预后最显著的3个因素。结论：肌层浸润深度、手术病理分期、组织学分级是影响子宫内膜癌手术预后的因素，但浸润肌层是影响子宫内膜癌手术预后的最重要的因素。

Abstract: Multivariate Analysis of Prognostic Factors of Endometrial Carcinoma by COX ProportionalHazard Regression ModelMinWANG, Zhihong MA,Chunxue SHICorrespondence to: MinWANG, E-mail: wm21st@126.comDepartment of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang 110004, ChinaAbstract Objective: To evaluate various clinical characteristics ( menopause, clinical and surgical surgical stage, histologicalgrade, myometrial invasion, lymph node transmission, pathological stage and adjuvant therapy ) and biological factors ( ER, PR,COX-2, VEGF and KDR expression ) for prognosis of endometrial carcinoma, and to analyze the clinical characteristics and biologicalfactors by univariate and multivariate analysis in order to comprehensively evaluate the effect of clinical and biological factors on endo-metrial carcinoma and select the most significant factor for prognosis. Methods: The clinical and biological factors were analyzed byunivariate analysis and multivariate analysis through COX proportional hazard regression model. Results: One hundred thirty-seven en-dometrial carcinoma cases were investigated, and 112 were followed-up successfully. The five-year survival rate was 83.04%. Thefive-year survival rates of stage Ⅰto Ⅳ were 89.66%, 80%, 53.85%, and 0%, respectively. The expression rates were 47.32% forCOX-2, 66.07% for VEGF and 52.68% for KDR. The five-year accumulated survival rate was 75.47% for endometrial carcinoma withdetectable COX-2 expression, 78.38% for endometrial carcinoma with detectable VEGF, and 72.88% for endometrial carcinoma withdetectable KDR expression. By analyzing the 7 clinical factors and 5 biological factors through univariate analysis, the clinical and sur-gical stage, myometrial invasion, histological grade, lymph node transmission, COX-2 positive status, KDR positive status, ER positivestatus, and PR positive status were associated with prognosis ( P < 0.05 ), while menopause, pathological stage, adjuvant therapy andVEGF positive status were not associated with prognosis ( P > 0.05 ). These 8 factors were analyzed by Cox proportional hazard regres-sion model analysis. Myometrial invasion, operate period, and histological grade were the most important factors for endometrial carci-noma prognosis. Conclusion: According to analysis by Cox proportional hazard regression model, myometrial invasion, operate period,and histological grade are the most important factors for endometrial carcinoma prognosis. These findings are significant for those for-mulating a prognosis and for the systematic treatment of endometrial carcinoma.Keywords Endometrial carcinoma; Clinical pathological and biological factors; Prognosis;COX proportional hazard regression model