子宫颈腺癌184例临床及预后分析

Analysis of Clinical Course and Prognostic Factors of 184 Cervical Adenocarcinoma

目的了解宫颈腺癌影响预后的相关因素。方法１８４例宫颈腺癌中，Ⅰ、Ⅱ期行广泛全子宫切除、盆髂淋巴结清扫术，部分病例加术前后装放疗２～３次；凡盆腔淋巴结转移者，术后补充盆髂野外照射治疗，凡肿瘤侵犯宫颈深肌层者行宫颈残端野放疗。部分病例辅以ＣＡＰ及ＣＢＰ盆腔动脉灌注化疗２～４疗程。Ⅲ、Ⅳ期则多行全量放疗加动脉插管化疗。结果总的５年存活率为５４２％，Ⅰ、Ⅱ、Ⅲ、Ⅳ期５年存活率分别为８２５％、６１３％、７７％、１６７％（Ｐ＜００１），宫颈肿瘤≥４ｃｍ和＜４ｃｍ者５年存活率分别为３５５％及６５５％（Ｐ＝０），有和无盆腔淋巴结转移的５年存活率分别为４０６％及７８７％（Ｐ＜００１）。结论宫颈腺癌的预后主要和临床分期、局部肿瘤大小、有无淋巴结转移关系密切。根治性手术或以根治性手术为主的综合治疗是治疗宫颈腺癌的主要方法。

Objective To clarify the prognostic factors of cervical adenocarcinoma. Methods From January,1982 to June,1998,184 patients with adenocarcinoma of cervix were analyzed retrospectively,including 33 patient of stage ,108 stage ,37 stage and 6 stage .Patients with stage + were treated by radical hysterectomy and bilateral pelvic lymphadenectomy,and preoperative intracavitary radiotherapy was given for some patients.Post-operative external radiotherapy were administered for patients with pelvic positive lymph nodes and deep muscle involvment.Some patients were given 2-4 courses of CAP regimen(CTX,ADM and DDP) and CBP regimen(CTX,BLM and DDP),and ADM,DDP and Carboplatin were infused through hypogastric artery.Patients of stage and were treated by radiotherapy and intraaterial chemotherapy. Results Overall 5 year survival rate was 542%,while 5 year survival rate of stage ,, and were 825%,613%,77% and 167% respectively(P=0).5 years survival rate for cervical lesion 4cm and <4cm and with and without pelvic lymph nodes involvement were 355% versus 655%(P=0),406% versus 787%(P=0)respectively.ZConclusion The prognostic factors of cervical adenocarcinoma were stage,bulky disease and lymph node involvement.Radical surgery and multidisciplinary treatment including radical surgery are the mainstay of treatment for cervical adenocarcinoma.