2 PATHOGENETIC TYPES OF ENDOMETRIAL CARCINOMA
2 PATHOGENETIC TYPES OF ENDOMETRIAL CARCINOMA
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DOI：
10.1016/0090-8258(83)90111-7
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发表时间：
1983-01-01
影响因子：
4.7
通讯作者：
BOKHMAN, JV
中科院分区：
文献类型：
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作者：
BOKHMAN, JV
本文提出了一种假说，认为早在子宫内膜癌发生之前就存在的内分泌和代谢紊乱的复合物决定了肿瘤的生物学特性、临床过程和疾病的预后。根据对366例子宫内膜癌患者的前瞻性研究，子宫内膜癌有2种不同的发病类型。该病的第一种发病类型出现在有肥胖、高脂血症和雌性激素过多症状的妇女身上：无排卵性子宫出血、不孕症、更年期迟发、卵巢和子宫内膜间质增生。该疾病的第二种致病类型出现在没有上述症状或这些症状不明确定义的妇女身上。第一种发病类型的发生率为65%，第二种发病类型的发生率为35%。上述特点是该病第一种发病类型的特征，决定了高分化和中分化肿瘤的发展（G1和G2占82.3%）、肌层浅表侵犯（69.4%）、对孕激素的高敏感性（80.2%）和良好的预后（85.6%的5年生存率）。在第二种病理类型的子宫内膜癌患者中，当内分泌和代谢紊乱不存在或隐匿时，出现低分化肿瘤（62.5% G3），肿瘤有向肌层深部浸润的趋势（65.7%）；骨盆淋巴结转移率高（27.8%）；孕激素敏感性降低（42.5%）；预后可疑（5年生存率58.5%）。
A hypothesis that the complex of endocrine and metabolic disturbances arising long before the development of endometrial carcinoma determines the biological peculiarities of the tumor, its clinical course and the prognosis of the disease is presented. On the basis of a prospective study of 366 patients with endometrial carcinoma, there are 2 different pathogenetic types of endometrial carcinoma. The 1st pathogenetic type of the disease arises in women with obesity, hyperlipidemia and signs of hyperestrogenism: anovulatory uterine bleeding, infertility, late onset of the menopause, and hyperplasia of the stroma of the ovaries and endometrium. The 2nd pathogenetic type of the disease arises in women who have no signs stated above or these signs are not clearly defined. The frequency of the 1st pathogenetic type in the studied group of women was 65%, whereas the frequency of the 2nd type was 35%. The peculiarities outlined above which are characteristic of the 1st pathogenetic type of the disease determine the development of highly and moderately differentiated tumors (82.3% G1 and G2), superficial invasion of the myometrium (69.4%), high sensitivity to progestogens (80.2%) and favorable prognosis (85.6% 5-yr survival rate). In patients who have the 2nd pathogenetic type of endometrial cancer when endocrine and metabolic disturbances are absent or occult, poorly differentiated tumors arise (62.5% G3), a tendency to deep invasion of tumor into the myometrium is observed (65.7%); high frequency of metastatic spread into the pelvic lymph nodes (27.8%); decrease of sensitivity to progestogens (42.5%); and doubtful prognosis (58.5% 5-yr survival rate) are noted.