84例非HPV相关宫颈腺癌临床病理分析  

Clinical and pathological analysis of 84 cases of non-HPV-associated endocervical adenocarcinoma

作　　者：曾浩然 陈晓琪 纪妹[1] Zeng Haoran;Chen Xiaoqi;Ji Mei(Department of Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000)

机构地区：[1]郑州大学第一附属医院妇科,郑州450000

出　　处：《现代妇产科进展》2025年第4期264-268,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨非HPV相关宫颈腺癌的临床特点、病理特征、治疗及预后,以提高对该疾病的认识,为临床诊治提供更多的参考依据。方法:回顾分析2019年1月至2023年12月郑州大学第一附属医院收治的84例非HPV相关宫颈腺癌患者的病例资料。采用Kaplan-Meier法及Log-rank检验分析相关因素与预后的关系。结果:84例患者中位年龄为50岁(29~71岁),主要临床表现为异常阴道出血和接触性出血。84例患者中,38例胃型腺癌,17例透明细胞癌,2例中肾管癌,27例子宫内膜样腺癌。按FIGO(2018版)分期,Ⅰ期36例(42.86%),Ⅱ期14例(16.67%),Ⅲ期29例(34.52%),Ⅳ期5例(5.95%)。低分化37例(44.05%),宫颈间质深层浸润(浸润深度≥1/2)60例(71.40%),淋巴结转移30例(35.71%),卵巢转移8例(9.52%)。1年、5年总生存率分别为91.3%、71.7%。K-M分析显示,FIGO分期、分化程度、间质浸润程度、淋巴结转移、卵巢转移与预后有关,而年龄、孕次、产次、流产次数、是否绝经、辅助治疗及病理亚型对预后无明显影响。结论:非HPV相关宫颈腺癌起病隐匿,临床表现及体征不典型,确诊时多为晚期,宫颈癌筛查阳性率不高,盆腔MRI及免疫组化对该病的鉴别至关重要。治疗以手术为主,不建议保留卵巢。分期晚、低分化、间质深浸润、有淋巴结转移及卵巢转移的患者预后往往较差。Objective:To explore the clinical characteristics,pathological features,treatment and prognosis of non-HPV-associated cervical adenocarcinoma(NHPVA),to improve the understanding of the disease and provide more reference for clinical diagnosis and treatment.Methods:The data of 84 patients with NHPVA in the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2023 were retrospectively analyzed.Kaplan-Meier test and Log-rank test were used to analyze the relationship between related factors and prognosis.Results:The median age of 84 patients was 50 years old(29~71years).The main clinical manifestations were abnormal vaginal bleeding and contact bleeding.Among the 84 patients,there were 38 cases of gastric-type adenocarcinoma,17 cases of clear cell adenocarcinoma,2 cases of mesonephric adenocarcinoma,and 27 cases of endometrioid adenocarcinoma.According to FIGO(2018)stage,there were 36 patients(42.86%)in stageⅠ,14 patients(16.67%)in stageⅡ,29 patients(34.52%)in stageⅢ,and 5 patients(5.95%)in stageⅣ.There were 37 cases(44.05%)with low differentiation,60 cases(71.40%)with deep interstitial infiltration,30 cases(35.71%)with lymphatic metastasis,and 8 cases(9.52%)with ovarian metastasis.The overall survival rates of the first and fifth years were 91.3%and 71.7%respectively.The K-M analysis showed that FIGO stage,degree of tumor differentiation,degree of interstitial infiltration,lymphatic metastasis,and ovarian metastasis were related to the prognosis of the disease,while age,pregnancy times,delivery times,abortion times,whether menopause,adjuvant therapy,and pathological subtypes had no significant influence on the prognosis.Conclusion:The biological behavior of NHPVA is relatively hidden.The clinical manifestations and signs are atypical,the diagnosis is mostly advanced,and the positive rate of cervical cancer screening is low.MRI and immunohistochemistry are very important for the differentiation of the disease.Surgery is the main treatment,and preservation of the ovaries is not reco

关 键 词：宫颈腺癌 非HPV相关性 临床特点 治疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]