[Clinicopathologic and survival analysis of synchronous primary endometrial and ovarian cancer].

Objective: To demonstrate the clinicopathological characteristics and determine the prognostic factors for women with synchronous primary endometrial and ovarian cancer (SEOC) . Methods: A retrospective analysis of 63 pathologically proven cases of SEOC diagnosed in Peking Union Medical College Hospital from January 2000 to May 2018 was carried out. Results: (1) Clinical features: mean age at diagnosis was (48.3±10.0) years, and the mean body mass index (BMI) was (23.4±3.7) kg/m(2). The most common presenting symptom was abnormal uterine bleeding with a ratio of 73% (46/63). Forty-three patients (68%, 43/63) were premenopausal, and 30% (19/63) were nulliparous. (2) Pathological features: for the endometrial cancer, 90% patients were diagnosed at stage Ⅰ, and 81% were low grade tumors (G(1)-G(2)). The histological type of endometrial cancer was mainly endometrioid carcinoma (86%) and majority (81%) of patients were proved without or with superficial myometrial invasion. For the ovarian cancer, 70% patients were diagnosed at stage Ⅰ and 65% were low grade tumors (G(1)-G(2)). Sixty-two percent of ovarian cancers were endometrioid carcinoma and 68% of patients had unilateral involvement of the ovaries. (3) Treatment and prognosis: all patients underwent surgery, of which 56 (89%) underwent staging surgery including retroperitoneal lymphadenectomy, and 57 (90%) received postoperative adjuvant therapy. The median follow-up time was 48.0 months (range, 2-176 months) , and 13% of the patients experienced tumor recurrence during the follow-up period. The median time to recurrence was 38.5 months, and 6 patients (10%) died of tumor recurrence. The 5-year progression-free survival (PFS) and 5-year overall survival (OS) for all patients were 69% and 80%, respectively. (4) Prognostic factors: univariate analysis showed that the presence of lymphovascular space invasion (LVSI) , non-endometrioid histology of ovarian cancer and stage of ovarian cancer above stage Ⅰ were associated with significantly worse PFS (P<0.05). LVSI, high grade of endometrial cancer, and above stage Ⅰ of ovarian cancer were associated with significantly worse OS (P<0.05). On multivariate analysis, LVSI, non-endometrioid type ovarian cancer and stage of ovarian cancer above stage Ⅰwere associated with significantly worse PFS (P<0.05). In addition, LVSI and stage of ovarian cancer above stage Ⅰ were also associated with significantly worse OS (P<0.05) . Conclusions: Women with SEOC are young, premenopausal and have a favorable overall prognosis. Presence of LVSI, non-endometrioid type ovarian cancer and stage of ovarian cancer above stage Ⅰ are independent prognostic factors for PFS, and stage of ovarian cancer above stage Ⅰare independent prognostic factors for OS.目的： 探讨子宫内膜和卵巢同期原发性双癌（SEOC）患者的临床病理特征点及预后影响因素。 方法： 回顾性分析2000年1月—2018年5月于中国医学科学院北京协和医院诊治并经病理检查证实的63例SEOC患者的临床病理资料，探讨SEOC的治疗及预后，并对影响SEOC患者预后的相关因素进行分析。 结果： （1）临床特点：63例SEOC患者诊断时的年龄为（48.3±10.0）岁，体质指数（BMI）为（23.4±3.7）kg/m(2)；首诊症状为异常子宫出血者占73%（46/63）；未生育者占30%（19/63），未绝经者占68%（43/63）。（2）病理特点：SEOC中的子宫内膜癌主要为低手术病理分期（Ⅰ期占90%）、低病理分级（G(1)~G(2)占81%），病理类型以子宫内膜样癌为主（占86%），浸润深度以无或浅肌层浸润为主（占81%）；SEOC中的卵巢上皮性癌（卵巢癌）主要为低手术病理分期（Ⅰ期占70%）、低病理分级（G(1)~G(2)占65%），病理类型以子宫内膜样癌为主（占62%），以卵巢单侧受累为主（占68%）。（3）治疗及预后：63例SEOC患者均接受了手术治疗，其中56例（89%）接受了包括腹膜后淋巴清扫在内的分期手术，57例（90%）接受了术后辅助治疗。中位随访时间为48.0个月（2~176个月），随访期间内复发8例（13%），复发的中位时间为38.5个月，死于肿瘤复发者6例（10%）；SEOC患者的5年无进展生存率（PFS）为69%，5年总生存率（OS）为80%。（4）预后影响因素分析：单因素分析显示，淋巴脉管间隙浸润（LVSI）、卵巢癌为非子宫内膜样癌、卵巢癌手术病理分期高于Ⅰ期者的5年PFS更差（P<0.05），LVSI、SEOC中子宫内膜癌为高病理分级、SEOC中卵巢癌的手术病理分期高于Ⅰ期者的5年OS更差（P<0.05）；多因素分析显示，LVSI、SEOC中卵巢癌的病理类型和手术病理分期为影响SEOC患者5年PFS的独立因素（P<0.05），LVSI、SEOC中卵巢癌的手术病理分期是影响SEOC患者5年OS的独立因素（P<0.05）。 结论： SEOC患者通常较为年轻，多为绝经前女性，预后较好。LVSI、卵巢癌为非子宫内膜样癌以及卵巢癌手术病理分期高于Ⅰ期是影响SEOC患者5年PFS的独立因素，而LVSI与卵巢癌手术病理分期高于Ⅰ期是影响SEOC患者5年OS的独立因素。.