宫颈腺鳞癌45例临床分析

Clinical analysis of 45 cases of adenosquamous carcinoma of the cervix

目的 ：分析宫颈腺鳞癌患者的临床特点、治疗方式,探讨临床病理参数与患者预后的相关性。方法 ：回顾性分析45例宫颈腺鳞癌患者的临床资料。结果：45例患者中位年龄42岁,其中40例以阴道异常出血为首发临床症状。所有患者治疗前病理确诊为腺鳞癌者为28例（62.22%）,早期宫颈腺鳞癌病理类型正确诊断率为41.38%。组织学分级中未见高分化者,低分化者27例（60.00%）,29例ⅠB1期-ⅡA2期患者中2例接受了单纯放疗,1例接受单纯手术治疗,其余均接受手术、放疗和（或）化疗的综合治疗。27例接受手术的早期宫颈腺鳞癌患者中,术后病理提示深间质浸润11例（40.74%）,淋巴结转移9例（33.33%）,脉管内见癌栓8例（29.63%）。晚期患者均接受同步放化疗或单纯化疗。患者总的5年生存率为68.89%,Ⅰ、Ⅱ、Ⅲ期患者的5年生存率分别为84.62%、66.67%和37.50%,生存率与临床分期明显相关（P〈0.05）。结论 ：宫颈腺鳞癌以低分化者为多见,常伴深间质浸润,即使早期患者也多需接受综合治疗,其预后与临床分期明显相关。

Objective： To evaluate the clinical characteristics and treatment method of adenosquamous carcinoma of cervix and to define the clinicopathologic features associated with the prognosis of patients. Methods： Forty-five patients with cervical adenosquamous carcinomas treated in our hospital were retrospectively analyzed. Results： The median age of the 45 patients was 42 and the first clinical symptom of 40 patients was abnormal vaginal bleeding. Only 27 patients were exactly diagnosed as adenosquamous carcinomas before treatment and the rate of accurate diagnosis before surgery was only 41.38%in early stage patients. There was no patient with grade 1 and twenty-seven of 45 patients（60.00%） were of grade 3. Two of 29 early stage patients received only radiotherapy and other one case received only surgery. The left patients received comprehensive treatment including surgery, radiotherapy and/or chemotherapy. The incidence rate of deep cervical stromal invasion,pelvic node metastases,and intravascular cancer emboli were 40.74%, 33.33% and 29.63% respectively in 27 early stage patients undergone surgery. The advanced stage patients received radiotherapy and concurrent chemotherapy or only chemotherapy. The 5-year survival rate was 68.89% and the 5-year survival rates of stageⅠ,Ⅱand Ⅲ were 84.62%, 66.67%and 37. 50 % respectively. There was significant difference between FIGO stage and the prognosis（ P〈0. 05）. Conclusion ：Cervical adenosquamous carcinoma is characterized poor differentiation and deep cervical stromal invasion. Early stage adenosquamous carcinoma of the cervix patients should also be treated with comprehensive methods. FIGO stage is a significant prognostic factor.