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目的 分析子宫内膜癌骨转移患者的临床病理特点及预后.方法 收集2004年1月—2017年12月在中国医学科学院北京协和医学院北京协和医院妇产科接受治疗的子宫内膜癌患者共2 458例,其中骨转移患者14例,包括与子宫内膜癌同时诊断的骨转移(初诊时诊断的骨转移)和子宫内膜癌复发时诊断的骨转移(复发时诊断的骨转移)各7例,随访截止至2018年7月或患者死亡日,中位随访时间为25.5个月(7.7~258.0个月).回顾性分析14例子宫内膜癌骨转移患者的临床病理特点、骨转移特点、治疗及预后.结果 北京协和医院2004—2017年间子宫内膜癌骨转移的发生率为0.57%(14/2 458).(1)一般临床病理特点:7例初诊时诊断的骨转移患者的中位年龄为50岁(32~66岁),7例复发时诊断的骨转移患者的中位年龄为57岁(50~70岁),两者比较差异无统计学意义(P=0.559);初诊时诊断的骨转移患者的主要病理类型为子宫内膜样癌(5例),复发时诊断的骨转移患者的病理类型均为子宫内膜样癌.(2)骨转移特点:子宫内膜癌发生骨转移最多见于骨盆骨,其次为胫骨等.(3)治疗:对于子宫内膜癌的治疗,采用以手术治疗为主的综合治疗;对于骨转移的治疗,根据患者情况,给予个体化的放化疗等综合治疗.(4)预后:14例子宫内膜癌骨转移患者中,随访期内9例死亡,中位总生存时间为22.0个月(7.0~255.0个月),诊断骨转移后的中位生存时间为15.0个月(3.0~51.0个月).子宫内膜癌患者诊断骨转移后,其1年生存率为71.4%,2年生存率为40.8%.(5)预后影响因素分析:Cox回归模型分析显示,骨转移部位数、合并其他部位转移、骨转移类型(指初诊时诊断、复发时诊断)、中轴骨(指躯干骨和头颅骨)转移对子宫内膜癌骨转移患者的预后均无明显影响(P>0.05).结论 子宫内膜癌骨转移的发生率低于1%,骨转移可以在诊断子宫内膜癌的同时或者子宫内膜癌复发时出现.子宫内膜癌发生骨转移提示患者的预后不良,目前没有标准的随访方式及治疗方案,治疗需要个体化.

Objective To analyze the clinicopathological features and prognosis of patients in endometrial cancer with bone metastases. Methods A retrospective review of medical records was performed to analyze patients with endometrial cancer who developed bone metastases at Peking Union Medical College Hospital (PUMCH) from January 2004 to December 2017, including patients with bone metastases at the diagnosis of endometrial cancer and at recurrence of endometrial cancer. The patient′s clinicopathological features, bone metastasis characteristics, treatment process and prognoses were also analyzed. Results The incidence of bone metastasis of endometrial cancer in PUMCH from 2004 to 2017 was 0.57% (14/2 458). (1) General clinical pathological features: the median age of the 7 patients with bone metastases diagnosed at the time of initial diagnosis was 50 years old, and the main pathological type was endometrioid carcinoma (n=5). The median age of the other 7 patients was 57 years old, with no significant difference comparing to the former groups (P=0.559). (2) The majority site of bone metastasis in endometrial cancer were discovered in pelvic bones, followed by the tibia. (3) Treatment: according to the staging of endometrial cancer, a comprehensive treatment based on surgery was performed, and one patient with isolated bone metastases underwent resection of bone metastasis. (4) Prognosis: nine out of the 14 patients died during the follow-up period. The median over all survival time was 25.5 months (range: 7.7-258.0 months). The median survival of population after diagnosis of bone metastases was 15.0 months (range: 3.0-51.0 months). The survival rate of endometrial cancer at 1-year after diagnosis of bone metastasis was 71.4%. The 2-year survival rate was 40.8%. (5) No independent prognostic factors affecting survival was found (P>0.05). Conclusions The incidence of bone metastasis in endometrial cancer is less than 1%. Bone metastasis could occur at the diagnosis of endometrial cancer or recurrence of endometrial cancer. Bone metastasis suggests a poor prognosis. There is no standard follow-up and treatment protocols so that individualized treatment is needed.