浸润宫体的Ⅰ_b～Ⅱ_a期宫颈癌临床病理特点与预后的探讨

Clinical characteristics and prognostic of uterine body invasion of stage Ⅰ_b and Ⅱ_a uterine cervix carcinoma

背景与目的:宫颈癌在分期中未考虑是否侵及宫体,但近来有研究报道了宫颈癌宫体浸润可能是影响预后的一个重要因素。故本研究探讨了浸润宫体的Ⅰb～Ⅱa期宫颈癌的临床特点。方法:回顾性分析浙江省肿瘤医院妇瘤科2006年9月-2008年4月收治的406例初始治疗行广泛性子宫切除+盆腔淋巴结清扫的Ⅰb～Ⅱa期宫颈癌患者临床与病理资料,根据癌灶有无浸润宫体分为研究组(浸润宫体的宫颈癌共69例)和对照组(未浸润宫体的宫颈癌共337例)。分析两组患者的发病年龄,肿瘤情况,包括临床分期、肿瘤直径,病理类型、病理分化程度、浸润深度、淋巴结转移情况及脉管内瘤栓情况。结果:单因素分析结果显示,研究组较对照组临床分期晚、肿瘤直径大、浸润深度深、淋巴结转移情况多见,差异均有显著型(P<0.01),且病理类型中非鳞癌(non-squamous cell cancer,non-SqCC)比例增高,差异有显著性(P<0.01)。logistical多因素分析显示临床分期晚、肿瘤直径大、浸润深度深、非鳞癌是宫颈癌浸润宫体的独立危险因素(P<0.05或P<0.01)。结论:临床分期晚、肿瘤直径大、浸润深度深、非鳞癌可能是宫颈癌浸润宫体的主要危险因素,宫体浸润可能为影响宫颈癌预后的一个重要因素,其治疗也值得进一步探讨。

Background and purpose： Uterine body invasion of carcinoma of the uterine cervix is not in the International Federation of Gynecology and Obstetrics（FIGO） staging system. Some reports suggested that uterine body invasion of carcinoma of the uterine cervix was an important prognostic factor. The aim of this study was to investigate the clinical characteristics and prognosis of the uterine cervix carcinoma with uterine body invasion. Methods： The clinicopathologic records of 406 patients with carcinoma of the uterine cervix of stage Ⅰb -Ⅱa who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively analyzed, the number of uterine body invasion was 69 in all cases. On the contrary, the negative number was 337. We studied the general condition（age of onset） and tumor conditions,including clinical stage, tumor diameter, pathological type, pathology differentiated degree, positive pelvic lymph nodes, deep stromal invasion, and lymph vascular space involvement. Results： In univariate survival analysis, the incidence of stage Ⅱa, non-squamous cell cancer（non-SqCC）, tumor size≥〉4 cm, deep stromal invasion and positive pelvic lymph nodes were significantly higher in carcinoma of the uterine cervix with uterine body invasion than those in control group（P〈0.01）. While in multivariate survival analysis, stage Ⅱa, tumor size≥4 cm, deep stromal invasion and non-SqCC were independent risk factors of carcinoma of the uterine cervix with uterine body invasion （P〈0.05 or P〈0.01）. Conclusion： Stage Ⅱ a, tumor Size≥4 cm, deep stromal invasion and non-SqCC may be the main risk factors of uterine body invasion of carcinoma of the uterine cervix. These results suggest that uterine body invasion of carcinoma of the uterine cervix is probably an important prognostic factor and treatment should be modified in such cases.