中文摘要：

目的初步探讨成人合并症评估-27（ACE-27）评分系统在子宫内膜癌中的临床应用。方法收集1985年1月—2015年12月间天津医科大学总医院妇产科收治的有完整临床病理资料及随访资料的子宫内膜癌患者共847例，所有患者均行手术治疗，术前均行放疗、化疗、激素治疗等辅助治疗，患者中位年龄为57.6岁（25～85岁），中位随访时间为59.0个月（2～312个月）。（1）采用ACE-27评分系统对所有患者的内科合并症进行评分；（2）应用Kaplan-Meier法绘制生存曲线，比较不同ACE-27评分的子宫内膜癌患者的生存情况及术后辅助放化疗情况；（3）采用Cox回归模型对影响子宫内膜癌患者预后的因素进行单因素及多因素分析。结果（1）ACE-27评分：847例子宫内膜癌患者中，ACE-27评分为0分者311例（36.7%）、1分者263例（31.1%）、2分者132例（15.6%）、3分者141例（16.6%）。（2）不同ACE-27评分的子宫内膜癌患者的生存情况：应用Kaplan-Meier法绘制生存曲线，结果显示，随着ACE-27评分的增高，子宫内膜癌患者的总生存时间明显缩短（χ2=19.003，P=0.000）。进一步按照以下因素进行分层后显示，体质指数（BMI）〈25 kg/m2和25～〈30 kg/m2、手术病理分期为Ⅰ期、病理类型为子宫内膜样腺癌的患者，随着ACE-27评分的增高，其总生存时间均明显缩短（P〈0.05）；而BMI≥30 kg/m2、手术病理分期为Ⅱ～Ⅳ期、病理类型为非子宫内膜样腺癌的患者，随着ACE-27评分的增高，其总生存时间均无明显变化（P〉0.05）。不同ACE-27评分的子宫内膜癌患者的术后辅助放化疗：手术病理分期为Ⅲ、Ⅳ期的子宫内膜癌患者，随着ACE-27评分的增高，其术后辅助放化疗比例虽有下降趋势，但差异均无统计学意义（P〉0.05）。（3）影响子宫内膜癌患者预后的因素分析结果：单因素分析显示，ACE-27评分为3分患者的死亡风

英文摘要：

Objective To investigate the significant role of the clinical application of adult comorbidity evaluation-27 （ACE-27） in endometrial cancer （EC）. Methods A total of 847 EC patients were included during Jan. 1985 to Dec. 2015 from Tianjin Medical University General Hospital. The clinical data of the patients were collected and analyzed retrospectively. All of the patients were received operation with no chemotherapy and radiotherapy before operation. The average age was 57.6 years old （range from 25 to 85 years old）. The average follow-up period was 59.0 months （range from 2 to 312 months）. The comorbidity of the patients was evaluated by ACE-27. EC patients survival was analyzed by Kaplan-Meier survival curve. The relationship between the prognosis of EC and ACE-27, age, body mass index （BMI）, pathological characteristic were showed by Cox modeling. Results （1）The patient number of score 0, 1, 2 and 3 of ACE-27 in EC patients were respectively 311 （36.7%）, 263 （31.1%）, 132 （15.6%） and 141 （16.6%） cases. （2）Kaplan-Meier survival curve analysis showed that overall survival time of EC patients was gradually decreased as increased score of ACE-27（χ2=19.003,P=0.000）. In the patients of BMI〈25 kg/m2 and BMI 25-〈30 kg/m2, International Federation of Gynecology and Obstetrics （FIGO） stage Ⅰ, endometrial adenocarcinoma type and the overall survival time of those EC patients were gradually decreased as increased score of ACE-27（P〈0.05）. However,there was no statistically significant difference in overall survival time for patients with BMI≥30 kg/m2, FIGO stage withⅡ-Ⅳand non-endometrial adenocarcinoma type （P〉0.05）. Per unvariate logistic modeling showed that the risk of death in score 3 of ACE-27 was increased compared with score 0 of ACE-27 （OR=2.53, P=0.000）. The overall survival time in EC patients with aged 50-59, 60-69 and≥70 years old, BMI 25-〈30 kg/m2 and≥30 kg/m2, G3, FIGO stageⅡ-Ⅳand non-endometrial adenocarcinoma type were