宫颈粘液腺癌48例临床病理分析  

Clinical pathologic analysis of 48 patients with mucinous adenocarcinoma of the uterine cervix

作　　者：刘鹏飞[1] 李洁[1] 吴鸣[1] 沈铿[1] 黄惠芳[1] 向阳[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院妇产科,北京100730

出　　处：《生殖医学杂志》2016年第3期226-231,共6页Journal of Reproductive Medicine

基　　金：国家自然基金项目(81472446)

摘　　要：目的探讨宫颈粘液腺癌患者治疗后的近期和远期疗效,并分析其预后影响因素。方法收集中国医学科学院北京协和医院2000年1月至2014年10月收治的48例宫颈粘液腺癌患者的临床病理资料,分析其年龄分布、临床病理特点、治疗、预后及相关影响因素。结果患者中位年龄为43岁（23～72岁）;临床分期：IA2期1例,IB1期16例,IB2期12例,IIA期5例,IIB期9例,III期4例,IV期1例;病理分型：宫颈管型38例,肠型1例,胃型（微偏腺癌）7例,印戒细胞型2例;宫颈局部肿瘤直径：≤4cm者30例,〉4cm者18例。术后病理发现：33例子宫颈深间质受侵（浸润深度≥1/2）,11例淋巴血管间隙受累（LVSI）,14例盆腔和（或）腹主动脉旁淋巴结有转移。48例宫颈粘液腺癌患者中,近期疗效有效率〉75%,随访期内死亡者共20例,5年累积总生存率49%,中位总生存时间为68个月。随访期内共21例患者术后出现复发、转移,中位复发、转移时间为12个月（1～55个月）。20例已死亡,1例带瘤生存。单因素生存分析显示,宫颈粘液腺癌患者的预后与肿瘤大小、脉管瘤栓、宫旁侵犯及淋巴结转移显著相关（P〈0.05）;多因素分析显示：仅淋巴结转移与否是独立的预后影响因素（P〈0.001）。结论宫颈粘液腺癌患者的总体预后较差,发生淋巴结转移是影响其预后的重要不良因素。Objective： To analyze the short-term and long-term treatment effect on cervical mucinous adenocarcinoma and its prognostic factors. Methods： The data of forty eight patients with mucinous adenocarcinoma of the uterine cervix diagnosed and treated in Peking Union Medical College Hospital from January 2000 to October 2014 were analyzed retrospectively. The data included clinic pathological characteristics, treatment ,and prognosis. Results： The patients~ median age was 43 years （range,23-72 years）. Clinical stage was as follows-1 case stage IA1,16 cases stage IB1,12 cases stage IB2,5 cases stage IIA, 9 cases stage IIB, 4 cases stage III, 1 case stage IV. Pathologic types was as follows.38 cases of endocervical type, 1 case of intestinal type,7 cases of gastric type, 2 cases of signet-ring cell type. The diameter of cervical tumor was as follows. 30 cases≤4 cm, 18 cases〉4 cm. Pathologic examination showed that 33 cases with cervical deep stromal invasion （thickness≥1/2）,11 cases with lymph-vascular space invasion （LVSI）,and 14 cases with pelvic and （or） para-aortic lymph nodes metastasis. Among 48 patients with mucinous adenocarcinoma of uterine cervix,twenty patients died during the follow-up period. The cumulative overall survival （OS） of 5 years was 49%, and the median overall survival time was 68 months. Twenty patients had recurrence and metastasis,and the median recurrence and metastasis time was 12 months （range, 1-55 months）. Among 21 patients with recurrence and metastasis, 20 patients died and 1 patient was survival with tumor-bearing. The univariate analysis showed that tumor size, vascular tumor thrombus, LVSI,and pelvic and para-aortic lymph nodes metastasis were the significant prognostic factors （P 〈 0.05）. The multivariate analysis showed that pelvic and （or） para-aortic lymph nodes metastasis was the only significant prognostic factors （P=0. 000）. Conclusions： The prognosis of cervical mucinous adenocarcinoma is poor,and pelvic and （or） para-

关 键 词：宫颈肿瘤 腺癌 粘液 肿瘤分期 子宫切除术 预后 

分 类 号：R714.22[医药卫生—妇产科学]