【摘要】 目的:探讨子宫内膜癌患者卵巢受累的危险因素及错配修复(MMR)蛋白表达状态在子宫内膜癌卵巢受累中的预测价值，为年轻子宫内膜癌患者保留卵巢提供依据。方法:回顾分析2019年1月至2022年1月于山东大学齐鲁医院济南院区及青岛院区接受全面分期手术的782例子宫内膜癌患者的临床病理资料，免疫组化法检测MMR状态。结果:单因素分析显示，非子宫内膜样腺癌、低分化(G3)、肿瘤直径大于4cm、肿瘤位于宫角/输卵管或子宫下段/宫颈、深肌层浸润、淋巴结转移、淋巴脉管浸润均与卵巢受累相关。多因素分析显示，肿瘤直径和肿瘤部位是子宫内膜样腺癌患者卵巢受累的独立危险因素。97例年龄≤45岁的患者中，9例卵巢受累，其病理类型均为子宫内膜样腺癌。8例在术前的影像学评估中即发现了一侧或双侧的卵巢肿物。MMR表达缺失仅与年龄大于45岁和淋巴脉管浸润相关，其卵巢受累发生率与MMR表达组患者基本一致。结论:年轻子宫内膜癌患者术前可通过影像学及宫腔镜检查来确定肿瘤的大小、位置及附件区情况，进一步评估保留卵巢的安全性。MMR蛋白表达状态与卵巢受累无关，提示制定卵巢保留的决策时可能不需考虑MMR状态。更多还原

【Abstract】 Objective:To explore the risk factors associated with ovarian involvement in endometrial cancer(EC) and the value of mismatch repair protein expression in predicting ovarian involvement in EC,and to provide a reference for clinical ovarian preservation in young women.Methods:782 EC patients who accepted surgical intervention at Qilu Hospital of Shandong University from January 2019 to January 2022 were analyzed.Clinicopathologic characteristics were collected from all patients and MMR status was determined using immunohistochemistry.Results:Univariate analysis revealed that non-endometrioid type, high-grade, tumor diameter>4cm, uterine horn/fallopian tube or lower uterine segment/cervix involvement, deeper myometrial invasion, lymph node metastasis, lymph-vascular space invasion were associated with ovarian involvement in EC patients.Multivariate analysis revealed that only tumor size and tumor location were independent risk factors.Among 97 young EC patients(aged ≤ 45 years),9 had coexisting ovarian tumors.All cases were endometrioid histology and 8 had suspicious ovarian masses on preoperative imaging.Patients with MMR-deficient tumours were older and had more lymph-vascular space invasion(LVSI) than patients with MMR-proficient tumours.However, no significant difference was found in the rate of ovarian involvement between the two groups.Conclusion:In young EC patients, to further evaluate the safety of ovarian preservation, preoperative imaging and hysteroscopy can be used to assessment tumor size, tumor location and adnexa.The risk of ovarian involvement in EC is not associated with MMR status, indicating that MMR status may not need to be considered when making decisions about ovarian preservation.更多还原