【作者】 吕欣；

【导师】 刘培淑；

【作者基本信息】 山东大学 ， 妇产科学（专业学位）， 2018， 硕士

【摘要】 目的:子宫内膜癌是最常见的女性生殖系统恶性肿瘤之一,严重威胁女性生命健康。术前对其进行准确评估以指导临床制定合理的治疗方案至关重要,对患者的预后判断亦具有重要意义。磁共振成像(MRI)具有多项优点,如多序列多方位成像、软组织分辨率高,在术前诊断及评估宫颈侵犯、肌层浸润、淋巴结转移中具有重要作用。血清糖类抗原CA-125广泛存在于体腔上皮来源的组织及相应肿瘤中,是子宫内膜癌患者的最常用肿瘤标志物之一。本研究通过回顾性分析,探讨MRI联合血清CA-125对子宫内膜癌诊断及术前评估中的价值。材料与方法:收集2005年12月至2015年12月于山东大学齐鲁医院就诊,病例资料完整且经手术病理证实为子宫内膜癌的患者60例为研究组,术前均行盆腔MRI检查及血清CA-125检查,且排除患有其它恶性肿瘤。另采集健康体检者60例血清CA-125作为对照组,整理数据后,应用统计软件进行处理,分别评价术前MRI检查及血清CA-125对子宫内膜癌分期的诊断价值。将术后病理特征与血清CA-125阳性率进行比较,评价血清CA-125对子宫内膜癌肌层浸润、宫颈浸润、淋巴结转移的评估价值。随后,将术前MRI检查与血清CA-125评估肌层浸润、宫颈浸润、淋巴结转移情况相比较,对比二者术前评估中的价值。结果:1.子宫内膜癌患者临床病理资料分析1.1子宫内膜癌患者一般资料子宫内膜癌患者60例,年龄25～78岁,平均年龄53.7±9.3岁;月经史:绝经后39例(65.0%),未绝经21例(35.0%)。1.2子宫内膜癌患者手术病理分期子宫内膜癌患者60例,FIGO分期为I A期45例(75.0%),Ⅰ B期4例(6.7%),Ⅱ期 5 例(8.3%),Ⅲ期 5 例(8.3%),Ⅳ期 1 例(1.7%)。1.3子宫内膜癌患者术后病理分级子宫内膜癌患者60例,G1级(低级别,高分化)36例(60.0%),G2级(中级别,中分化)14例(23.3%),G3级(高级别,低分化)10例(16.7%)。1.4子宫内膜癌患者术后病理类型子宫内膜癌患者60例,子宫内膜样腺癌54例(90.0%),非子宫内膜样腺癌6例(10.0%),其中浆液性癌4例、透明细胞癌1例、腺鳞癌1例。2.子宫内膜癌不同辅助检查方法与术后病理诊断结果比较2.1子宫内膜癌术前MRI分期与术后病理分期比较2.1.1子宫内膜癌MRI分期与病理分期总检出率为81.7%(49/60)。2.1.2子宫内膜癌MRI分期与病理分期准确率为77.6%(38/49)。2.1.3 一致性检验结果显示术前子宫内膜癌MRI诊断分期与术后病理分期具有一致性(K=0.504,P=0.000)。2.2子宫内膜癌术前血清CA-125与术后病理诊断结果比较2.2.1研究组与对照组血清CA-125比较子宫内膜癌患者术前血清CA-125水平与对照组相比,差异具有统计学意义(U=872.0,P=0.000)。2.2.2子宫内膜癌血清CA-125与FIGO病理分期比较随着FIGO病理分期的增高,子宫内膜癌患者血清CA-125阳性率增高(χ2=9.080,P=0.011)。2.2.3子宫内膜癌血清CA-125与术后病理特征比较2.2.3.1子宫内膜癌血清CA-125与肌层浸润比较随着浸润深度的增加,子宫内膜癌患者血清CA-125阳性率升高,差异具有统计学意义(χ2=7.581,P=0.023)。2.2.3.2子宫内膜癌血清CA-125与宫颈浸润比较子宫内膜癌宫颈浸润者与无浸润者相比,血清CA-125阳性率差异具有统计学意义(χ2=4.055,P=0.044)。2.2.3.3子宫内膜癌血清CA-125与淋巴结转移比较子宫内膜癌患者淋巴结阳性与淋巴结阴性相比,血清CA-125阳性率差异具有统计学意义(χ2=4.485,P=0.034)。3.MRI检查与血清CA-125对子宫内膜癌术前评估价值的比较3.1子宫内膜癌血清CA-125诊断临界值由ROC曲线获得,截断点为25.075U/ml,曲线下面面积为0.758。以血清CA-125>25.075 U/ml判断为阳性,60例子宫内膜癌患者中,28例阳性(46.7%),敏感度与特异度分别为46.7%、93.7%。3.2 MRI与血清CA-125在子宫内膜癌病理结果中的比较3.2.1 MRI与血清CA-125对子宫内膜癌病理分期评估的比较子宫内膜癌患者60例,Ⅰ期患者49例,Ⅱ期患者5例,Ⅲ+Ⅳ期患者6例,MRI检查的敏感性与血清CA-125的阳性率相比,差异无统计学意义(χ2=3.693,P=0.158)。3.2.2 MRI与血清CA-125对子宫内膜癌肌层浸润评估的比较子宫内膜癌患者60例,肌层浸润50例,其中,肌层浸润程度<1/2 39例,肌层浸润程度≥1/2 11例,MRI检查敏感性与血清CA-125阳性率相比,差异无统计学意义(χ2=3.211,P=0.073)。3.2.3 MRI与血清CA-125对子宫内膜癌淋巴结转移评估的比较子宫内膜癌患者60例,49例行盆腔淋巴结清扫土腹主动脉旁淋巴结清扫术,其中,淋巴结转移5例,无淋巴结转移44例,MRI检查敏感性与血清CA-125阳性率相比,差异无统计学意义(χ2=1.487,P=0.223)。3.2.4 MRI与血清CA-125对子宫内膜癌宫颈浸润评估的比较子宫内膜癌患者60例,8例患者发生宫颈浸润,52例患者无宫颈浸润,MRI检查敏感性与血清CA-125阳性率相比,差异具有统计学意义(χ2=4.603,P=0.032)。结论:1.MRI、血清CA-125对子宫内膜癌诊断具有重要价值。2.术前应用MRI检查联合血清CA-125可为临床提供较为准确的子宫内膜癌病理分期,评估肌层浸润深度、淋巴结转移、宫颈浸润,有助于临床制定个体化治疗方案。更多还原

【Abstract】 Objective:To compare preoperative MRI examination and serum CA-125 with postoperative pathology and to explore the clinical significance of preoperative MRI examination and tumor marker CA-125 in endometrial carcinoma patients.Methods:60 patients of endometrial carcinoma,who were admitted to the Department of Obstetrics and Gynecology,QiLu Hospital,Shandong University,participated our study,during December 2005 to December 2015.All patients received preoperative MRI examination and serum CA-125 testing,and the clinical data were complete.The other healthy subjects were enrolled in control group,and everyone got serum CA-125 testing.Statistical software was utilized to compare MRI examination and serum CA-125 with pathological staging,respectively.Also,assessment value of serum CA-125 in mucosal invasion,cervical invasion and lymph node metastasis was analyzed.At last,based on the pathological examination,the assessment value of MRI examination and serum CA-125 in mucosal invasion,cervical invasion and lymph node metastasis was analyzed.Results:1.Clinical characteristics of the patients1.1 General informationThe average age of the sample was 53.7±9.3 years old(with a range of 25～78 years of age).Of all patients,39 cases(65.0%)had gone through the menopause,and 21 cases were un-menopausal women.1.2 FIGO stagingBased on the FIGO staging,45 cases(75.0%)were in stage Ⅰ A,4 cases(6.7%)were in stage Ⅰ B,5 cases(8.3%)were in stage Ⅱ,5 cases(8.3%)were in stageⅢ and one patient was in stage Ⅳ.1.3 Pathological gradeIn terms of pathological grade,well differentiated cancer occurred in 36 patients(60.0%),moderately differentiated cancer occurred in 14 patients(23.3%),and low differentiated cancer occurred in 10 patients(16.7%).1.4 Histological typeIn terms of histological type,54 patients(90.0%)were endometrioid adenocarcinoma and 6 patients(10.0%)were non endometrioid adenocarcinoma.2.Different examinations compared with pathologic diagnosis.2.1 MRI compared with FIGO staging2.1.1 Over all detection rate of MRI examination was 81.7%(49/60).2.1.2 Over all accuracy rate of MRI examination was 77.6%(38/49).2.1.3 Consistency checks showed MRI examination and pathological examination were in line with each other in staging.2.2 Different values of preoperative CA-125 in clinic pathological aspects2.2.1 Difference of CA-125 between study group and control groupComparing the preoperative serum CA-125 level of cancer patients and control group,the parameters showed a significant relationship(U=872.0,P=0.000).2.2.2 CA-125 compared with FIGO staging Based on the FIGO staging,high CA-125 level had significant relationship with pathological stages(x2=9.080,P=0.011).2.2.3 CA-125 compared with pathological characteristics2.2.3.1 CA-125 compared with Myometrial invasionThe positive rate of serum CA-125 was significantly related to myometrial invasion(x2=7.581,P=0.023).2.2.3.2 CA-125 compared with Cervical invasionThe positive rate of serum CA-125 was significantly associated with cervical invasion(x2=4.055,P=0.044).2.2.3.3 CA-125 compared with Lymphatic metastasisThe positive rate of serum CA-125 was significantly related tolymphatic metastasis(x2=4.485,P=0.034).3.Preoperative MRI compared with serum CA-1253.1 The suitable cut-off value for CA-125According to the ROC curve,we arrived that the cut-off value was 25.075U/ml.The area under the ROC curve was 0.758.The positive rates of serum CA-125 was 46.7%.The sensitivity and specificity were 46.7%and 93.7%,respectively.3.2 MRI compared with CA-125 in pathological characteristics3.2.1 MRI compared with CA-125 in FIGO stagingComparing the diagnosis of pathological stages of MRI examination and positive rate of serum CA-125,preoperative MRI diagnosis sensitivity was similar to the positive rate of serum CA-125(x2=3.693,P=0.158).3.2.2 MRI compared with CA-125 in myometrial invasionAssessing myometrial invasion or not,there was no statistically significant differences between MRI diagnosis sensitivity and the positive rate of serum CA-125(x2=3.211,P=0.073).3.2.3 MRI compared with CA-125 in Lymphatic metastasisIn the aspect of lymphatic metastasis,the two ways were not statistically significant(x2=1.487,P=0.223).3.2.4 MRI compared with CA-125 in cervical invasionThe diagnostic sensitivity of MRI assessing cervical invasion or not was 60.0%(3/5),97.7%(43/44),while the positive of serum CA-125 was 62.5%(5/8),44.2%(23/52).The two diagnostic methods were statistically significant(X2=4.603,P=0.032).Conclusions:1.MRI and serum CA-125 testing are of great important tool for diagnosis of endometrial carcinoma.2.Preoperative MRI examination and serum CA-125 in the diagnosis of staging,myometrial invasion,cervical invasion and lymphatic metastasis are of great importance.更多还原