早期宫颈腺癌及腺鳞癌病人术后临床预后分析  

Clinical prognosis analysis of postoperative early stage adenocarcinoma and adenosquamous carcinoma of cervix

作　　者：冯冠男[1] 陆维仙 胡群超[2] 顾科[2] FENG Guannan;LU Weixian;HU Qunchao;GU Ke(Department of Gynaecology and Obstetrics,Suzhou Municipal Hospital (East Zone)/Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu 215000,China;Department of Radiation Oncology,Suzhou Municipal Hospital (East Zone)/Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu 215000,China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院东区妇产科,江苏苏州215000 [2]南京医科大学附属苏州医院苏州市立医院东区放疗科,江苏苏州215000

出　　处：《安徽医药》2019年第6期1199-1203,共5页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省重点研发计划社会发展项目(BE2015645)

摘　　要：目的探讨早期宫颈腺癌及腺鳞癌病人术后复发模式及临床预后。方法收集南京医科大学附属苏州医院2009年4月至2017年10月期间收治的早期宫颈腺癌及腺鳞癌病人共56例,回顾性分析其临床病理特征及不同治疗方式对肿瘤复发、疾病预后的影响。结果中位随访时间为33个月(5.3～108个月),期间有6例病人出现腹盆腔淋巴结转移,1例骨转移,3例肺和淋巴结多灶远处转移。总体病人5年无病生存率(DFS)及总生存率(OS)分别为78.4%和81.6%,其中ⅠA1～ⅠB2期病人的DFS明显优于ⅡA期,其5年DFS分别为87%、56%(P=0.001)。术后病理证实伴有脉管侵犯的病人,其5年DFS仅47.9%(P=0.001)。肿瘤大小、分化程度、淋巴结转移状态、神经侵犯及术后辅助放化疗对肿瘤复发转移及疾病生存预后未见明显影响。COX多因素分析显示,ⅡA期病人疾病进展风险较Ⅰ期病人提高(P=0.021)。结论国际妇产科联盟(FIGO)分期及脉管侵犯状态是影响早期可手术宫颈腺癌及腺鳞癌病人复发转移的重要因素,而其对疾病生存预后的影响仍有待长期的随访结果进一步验证。Objective To investigate the recurrence pattern of operable early stage adenocarcinoma and adenosquamous carcinoma of cervix and its clinical prognosis.Methods Fifty-six patients with adenocarcinoma or adenosquamous carcinoma of cervix admitted to Suzhou Hospital Affiliated to Nanjing Medical University from April 2009 to October 2017 were enrolled.The effects of the clinical and pathological features and different treatments on tumor recurrence and disease prognosis were retrospectively analyzed.Results With median follow-up of 33 months(range 5.3-108 months),six patients developed regional lymph nodes recurrence,one case had distant metastasis of bone,and three cases had distant metastasis of lung parenchyma and lymph nodes.Five-year disease-free survival(DFS)and overall survival(OS)rate of patients were 78.4%and 81.6%,respectively.The DFS of patients with stageⅠA1 toⅠB2 was significantly better than that of patients with stageⅡA,and the 5-year DFS rates were 87%and 56%,respectively(P=0.001).Patients confirmed as positive lymph vascular invasion presented decreased 5-year DFS of 47.9%(P=0.001).Tumor size,histologic grade,positive lymph node status,nerve infiltration,and postoperative adjuvant chemoradiotherapy had no significant impacts on tumor recurrence and metastasis or disease-free survival prognosis.The results of the multivariate analysis showed that patients with stageⅡA had relatively higher recurrence risk compared with those with stageⅠ(P=0.021).Conclusion The International Federation of Obstetricians and Gynecologists(FIGO)staging and lymph vascular invasion status are important factors influencing the recurrence and metastasis of operable early stage adenocarcinoma and adenosquamous carcinomas of cervix.The influencing factors of prognosis of disease-free survival remain to be further verified by long-term follow-up results.

关 键 词：宫颈肿瘤 腺癌 腺鳞癌 国际妇产科联盟(FIGO)分期 

分 类 号：R737.33[医药卫生—肿瘤]