ⅠB～ⅡA期宫颈腺鳞癌及腺癌患者的临床病理特征及生存预后分析  

Clinicopathologic features and prognostic analysis of stage Ⅰ B-Ⅱ A cervical adenosquamous carcinoma and adenocarcinoma

作　　者：吴婉莉[1] 于爱军[1] 

机构地区：[1]浙江省肿瘤医院妇瘤科,杭州310022

出　　处：《中华全科医师杂志》2016年第6期449-454,共6页Chinese Journal of General Practitioners

摘　　要：目的 了解早期宫颈腺鳞癌、腺癌患者的临床病理特征及生存预后.方法 收集2006年6月至2012年2月手术＋辅助放疗的62例ⅠB～ⅡA期宫颈腺鳞癌、149例腺癌和2 687例鳞癌患者的临床资料,采用χ2检验、Kaplan-Meier法、log-rank检验、logistic回归分析行统计学分析.结果 腺癌、腺鳞癌较鳞癌患者的淋巴结转移[33.6％（50/149）,29.0％（18/62）,22.0％ （591/2 687）]、深间质浸润（＞1/2） [64.4％ （96/149）,75.8％ （47/62）,55.3％（1 486/2 687）]及宫体受侵比例[26.2％（39/149）,25.8％ （16/62）,6.7％（181/2 687）]更高（χ^2=12.170,P=0.002;χ^2=14.660,P=0.001;χ^2 =97.732,P=0.000）.腺癌与腺鳞癌的巨块型肿瘤[≥4 cm,38.9％（58/149）与35.5（22/62）]、淋巴结转移、官体受侵、深间质浸润和低分化比例[38.9％（58/149）与48.4％（30/62）]差异无统计学意义（χ2 =0.220,P=0.639;χ^2 =0.410,P=0.522;χ^2 =0.003,P=0.956;χ^2=2.595,P=0.107;χ^2=1.612,P=0.204）.中位随访时间：45（3 ～92）个月.多因素分析：影响腺鳞癌的预后因素为宫体侵犯（P=0.014,RR=3.393,95％CI：1.280 ～8.991）、年龄（P=0.000,RR=1.077,95％CI：1.037 ～1.117）和期别（P=0.007,RR=0.275,95％CI：0.108 ～0.699）;影响腺癌的预后因素为年龄（P =0.006,RR=1.025,95％ CI：1.007 ～1.043）和淋巴结转移（P=0.000,RR=2.525,95％ CI：1.547 ～4.120）.中位生存期：腺癌45个月,腺鳞癌46个月,鳞癌56个月,腺鳞癌与鳞癌、腺鳞癌与腺癌比较差异均无统计学意义（χ^2=1.347,P=0.246;χ2=1.808,P=0.179）.腺鳞癌与鳞癌[14.0％（7/50）与7.6％（175/2 298）,χ^2=1.968,P=0.161]、腺鳞癌与腺癌[14.0％（7/50）与22.1％（27/122）,χ^2=1.478,P=0.224]的复发率比较差异无统计学意义.结论 Ⅰ B～ⅡA期宫颈腺鳞癌和腺癌临床病理特征类似,宫体侵犯、年龄、期别和年龄、淋巴结转移分别影响腺鳞癌和腺癌预后,腺鳞癌生存预后与腺癌无区别.Objective To analyze the clinicopathologic features and prognosis of early stage cervical adenosquamous carcinoma and adenocarcinoma.Methods Clinical data of 62 patients with cervical adenosquamous carcinoma,149 patients with adenocarcinoma and 2 687 patients with squamous carcinoma of stage Ⅰ B-Ⅱ A,who received surgical treatment and adjuvant radiotherapy from June 2006 to February 2012 were retrospectively analyzed.The Chi-square test,Kaplan-Meier method,log-rank test and logistic regression were used for statistical analysis.Results In patients with adenosquamous carcinoma,adenocarcinoma and squamous carcinoma,the rates of lymph node metastasis were 33.6% （50/149）,29.0% （18/62） and 22.0% （591/2 687）,deep stromal invasion were 64.4% （96/149）,75.8% （47/62） and 55.3% （1 486/ 2 687） and corpus invasion were 26.2% （39/149）,25.8% （16/62） and 6.7% （181/2 687）,respectively.Those pathological parameters in adenosquamous carcinoma and adenocarcinoma were higher than those in squamous carcinoma （χ^2 =12.170,P=0.002;χ^2 =14.660,P=0.001;χ^2 =97.732,P=0.000）.There were no difference between adenocarcinoma and adenosquamous carcinoma in proportion of massive tumor （≥4 cm） [38.9% （58/149） vs.35.5 （22/62）,χ^2 =0.220,P =0.639],lymph node metastasis （χ^2 =0.410,P =0.522）,corpus invasion （χ^2 =0.003,P =0.956）,deep stromal invasion （χ^2 =2.595,P =0.107） and low differentiation[38.9% （58/149） vs.48.4% （30/62）,χ^2 =1.612,P=0.204].The median follow-up period was 45 （3-92） months.Multivariate analysis showed that corpus invasion （P =0.014,RR =3.393,95%CI：1.280-8.991）,age （P=0.000,RR =1.077,95% CI：1.037-1.117） and stage （P =0.007,RR =0.275,95% CI：0.108-0.699） were prognostic factors of adenosquamous carcinoma.Age （P =0.006,RR =1.025,95 % CI：1.007-1.043） and lymph node metastasis （P =0.000,RR =2.525,95% CI：1.547-4.120） affected the prognosis of adenocarcinoma.The median survival times for adenocarcinoma,adenosquamous c

关 键 词：宫颈肿瘤 腺癌 腺鳞癌 病理状态 体征和症状 预后 

分 类 号：R737.33[医药卫生—肿瘤]