Coexistence of adenomyosis and endometrioid endometrial cancer: Role in surgical guidance and prognosis estimation
Coexistence of adenomyosis and endometrioid endometrial cancer: Role in surgical guidance and prognosis estimation
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DOI：
10.3892/ol.2015.4032
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发表时间：
2016-02-01
期刊：
影响因子：
2.9
通讯作者：
Berretta, Roberto
中科院分区：
文献类型：
--
作者：
Gizzo, Salvatore;Patrelli, Tito Silvio;Berretta, Roberto
本研究的目的是诊断子宫内膜样癌（EEC）伴发子宫腺肌病（AM），以评估其作为肿瘤学预后标志物的价值。回顾性分析289例诊断为EEC的患者，他们接受了全子宫切除术、双侧输卵管卵巢切除术和盆腔淋巴结切除术。总队列包括A组中的37例患者（伴随AM和EEC的患者）和B组中的252例患者（仅受EEC影响的患者）。评估了以下因素：AM的存在或不存在、肿瘤分级、子宫肌层浸润深度、肿瘤大小、淋巴血管间隙受累、淋巴结状态、腹膜细胞学检查、同时检测子宫内膜增生或息肉样子宫内膜特征以及根据国际妇产科联合会（FIGO）分类的肿瘤分期。对子宫颈、子宫体、子宫肌瘤和子宫颈或子宫内膜息肉的不同切片进行子宫检查。当子宫内膜下缘与子宫内膜腺体和间质病灶之间的距离> 2.5 mm时，AM的诊断得到确认。可能时进行参数和非参数统计检验;连续变量采用Student t检验分析，分类变量采用卡方检验或Fisher精确检验分析。FIGO分期和分组之间的相关性被确定为显著的：83.8%的A组患者被归类为FIGO I期，而B组患者为68.7%。此外，A组在FIGO分期、肌层浸润、淋巴管间隙受累、淋巴结受累和肿瘤大小方面的分级较低。研究结果表明，在EEC患者的AM存在的术中评估可能有助于外科医生估计肿瘤风险，并在选择最合适的手术治疗。
The aim of the current study was to diagnose the concomitant presence of adenomyosis (AM) in endometrioid endometrial cancer (EEC) in order to evaluate its value as an oncological prognostic marker. A retrospective analysis of 289 patients diagnosed with EEC who underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic-lymphadenectomy was conducted. The total cohort included 37 patients in Group A (those with concomitant AM and EEC) and 252 patients in Group B (those affected only by EEC). The following factors were evaluated: Presence or absence of AM, tumor grade, depth of myometrial invasion, tumor size, lymphovascular space involvement, lymph node status, peritoneal cytology, concomitant detection of endometrial atypical-hyperplasia or polypoid endometrial features and tumor stage according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Uterine examination of different sections of uterine cervix, corpus, myomas and cervical or endometrial polyps was performed. The diagnosis of AM was confirmed when the distance between the lower border of the endometrium and the foci of the endometrial glands and stroma was > 2.5 mm. Parametric and nonparametric statistical tests were performed when possible; continuous variables were analyzed using a Student's t-test, and categorical variables were analyzed by the chi(2) test or Fisher's exact test. The association between FIGO stage and group was determined to be significant: 83.8% of Group A patients were categorized as FIGO stage I, vs. 68.7% of Group B patients. In addition, Group A was associated with lower grades in FIGO stage, myometrial invasion, lymphovascular space involvement, lymph node involvement and tumor size. The findings suggest that the intraoperative evaluation of the presence of AM in patients with EEC may aid surgeons in estimating oncological risk and in selecting the most appropriate surgical treatment.