胃癌与结直肠癌宫颈转移22例临床分析  

Metastatic carcinoma to the uterine cervix from the gastric and the colorectal:A study of 22 cases

作　　者：殷卓敏[1] 俞华[1] 

机构地区：[1]浙江省肿瘤医院妇科,浙江杭州310022

出　　处：《中国癌症杂志》2009年第3期210-213,共4页China Oncology

摘　　要：背景与目的:胃癌及结直肠癌宫颈转移十分罕见,治疗效果不理想。为此,本文对近年来我院收治的胃癌及结直肠癌宫颈转移患者的临床特点、治疗、预后等进行分析,为临床治疗提供依据。方法:回顾性分析我院1994年至2007年收治的22例胃及结直肠癌宫颈转移病例。对患者原发部位、病理类型、转移特点、总生存时间及预后等进行分析。结果:22例患者主要症状为阴道不规则出血(占54.5%)。预后不佳,单纯手术6例,单纯放疗3例,单纯化疗1例,手术、放疗及化疗三种手段中两种或三种联合治疗9例,放弃治疗3例。术后病理分析显示,胃癌转移者的宫体均有内膜受侵,而结直肠转移者的宫体均有浆膜肌层受侵。22例患者除3例仍在治疗中,1例失访外,其余18例均死亡,平均总生存期14.6个月。胃癌及结直肠癌宫颈转移患者的平均总生存时间分别为11.2个月和17.9个月。印戒细胞癌、粘液腺癌和高/中/低分化腺癌患者的平均总生存时间分别为10、13和18.1个月。放疗、手术和综合治疗患者的平均总生存期分别为:10.7、13.2和17.7个月。4例行根治性手术和5例行减瘤术患者的平均总生存期分别为22.3个月和7.8个月。结论:本组原发瘤为胃癌者的平均总生存期较结直肠癌者短。不同病理类型中,印戒细胞癌平均总生存期最短,其次为粘液腺癌。在所有患者中胃癌转移至宫颈的印戒细胞癌总生存期最短。胃癌宫颈转移除逆行淋巴道转移外,癌细胞经过输卵管、宫体而达到宫颈也可能为其转移途径;而结直肠癌宫颈转移的主要模式则是经腹膜播散,直接浸润转移到宫颈。预后不佳,原发肿瘤类型、病理类型及治疗方式可能为影响患者预后的主要因素。对于能手术的患者应选择以手术为主的综合治疗方案,手术及放疗的同时必须联合全身化疗。Background and purpose： It is rare that gastric and colorectal cancer metastasize to the uterine cervix. The study aimed to explore the treatment, prognosis,and the clinical features of metastatases of uterine cervix from gastric and colorectal cancer. Methods： 22 patients with metastatic carcinoma to the uterine cervix from gastric and colorectal cancer were treated from 1994 to 2007 in Cancer Hospital of Zhejiang Province. The clinical pathologic parameters and prognosis were analyzed retrospectively. Results： The ages of patients ranged from 29 to 74 years old with mean of 46.7 years. The main symptom of patients was vaginal bleeding （54.5%）. The primary tumor was gastric cancer in 10 cases and colorectal cancer in 12 cases. 6 cases received operation alone, 3 cases received radiotherapy alone, 1 case received chemotherapy alone, 9 cases were treated by the combination of chemotherapy, operation or radiotherapy, 3 cases were not treated. According to clinical pathologic parameters, if the primary tumor was gastric cancer, it metastasesed to endometrium of uterine body; if the primary tumor was colorectal cancer,the serosa and myometrial of uterine body were invaded. In 22 cases,3 cases were still under treatment, with one lost follow-up,and the others died, the mean overall survival was 14.6 months. The mean overall survival were 11.2 months for gastric cancer and 17.9 months for colorectal cancer respectively. The mean overall survival of signet-ring cell carcinoma, mucinous adenocarcinoma and adenocarcinoma（G1-G3） were 10 months, 13 months, and 18.1 months respectively. The mean overall survival for the patients treated by either radiotherapy, operation or the combination were 10.7 months,13.2 months and 17.7 months respectively. The mean overall survival for 4 patients treated by radical operation and 5 patients treated by tumor cell reduction-extinction technique were 22.3 months and 7.8 months respectively. Conclusion：The mean overall survival for the patients with metastases of uterine ce

关 键 词：子宫颈肿瘤 胃肿瘤 结直肠肿瘤 癌 腺泡细胞 肿瘤转移 

分 类 号：R73-37[医药卫生—肿瘤]