宫颈癌卵巢转移的临床病理分析

Study on clinicopathological variables for ovarian metastases in cervical carcinoma

目的探讨宫颈癌卵巢转移的发生率、临床病理特征及影响因素。方法对中山大学肿瘤防治中心妇科1980年1月至2002年12月手术治疗中切除卵巢的宫颈癌病例907例进行回顾性研究。结果本组Ⅰ～Ⅱ期宫颈癌的卵巢转移率为0.8%,其中鳞癌为0.4%,腺癌为2.1%,腺鳞癌为5.0%(P<0.001)。7例卵巢转移以单侧为主,均为镜下转移,转移灶主要位于卵巢门。单因素分析显示,卵巢转移与组织学类型、颈管深肌层浸润、宫体侵犯、宫旁侵犯有关(均P<0.05)。多因素分析显示,组织学类型(P=0.039)、颈管深肌层浸润(P=0.048)、宫旁侵犯(P=0.001)是宫颈癌卵巢转移的独立危险因素。结论Ⅰ～Ⅱ期宫颈癌中,腺癌、腺鳞癌的卵巢转移率明显高于鳞癌。血行转移可能是卵巢转移的主要途径之一。对年轻的早期宫颈癌患者,若组织学类型为腺癌或腺鳞癌、颈管肌层浸润≥1/2或宫旁侵犯,保留卵巢须慎重。

Objective Ovarian metastasis is rare in squamous cell carcinoma of the uterine cervix.It has been still controversial about the incidence of that in adenocarcinoma and adenosquamous carcinoma.And it is not very clear about the pathological feature and the route of ovarian metastasis in cervical cancer.The purpose of our study was to investigate the incidence and risk factors of ovarian metastases in cervical carcinoma,and to examine the clinicopathological variables associated with the metastasis.Methods The records of 907 cervical carcinoma patients who underwent radical hysterectomy including ovariectomy at Cancer Center of Sun Yat-sen University between January,1980 and December,2002 were retrospectively analyzed.Results The incidence of ovarian metastasis was 0.8% in all patients with stage Ⅰ-Ⅱ cervical carcinoma,0.4% in squamous cell carcinoma,2.0% in adenocarcinoma,and 5.0% in adenosquamous carcinoma （P0.001）.All ovarian metastatic lesions were unilateral,microscopic in size,and found at the ovarian hilus.Univariate analysis showed that ovarian metastasis was associated with histologic type,deep myometrial invasion,endometrial invasion,and parametrial invasion （P0.05）.Logistic regression analysis indicated that histologic type （P=0.036）,deep myometrial invasion （P=0.043） and parametrial invasion （P=0.001） were significant risk factors for ovarian metastasis.Conclusions In stage Ⅰ-Ⅱ cervical carcinoma,the incidence of ovarian metastasis in adenocarcinoma and adenosquamous carcinoma was higher than that in squamous cell carcinoma.Ovarian metastasis may occur via hematogenous spread of cervical carcinoma.It may be unsafe to preserve the ovary if there is deep myometrial invasion or parametrial invasion or if the patient has adenocarcinoma or adenosquamous carcinoma.