ⅠB1期宫颈腺癌和鳞癌患者保留卵巢的临床病理特征比较

Comparison of clinical pathological characteristics in ovarian preserving patients with stageⅠB1 cervical adenocarcinoma and squamous cell carcinoma

目的:探讨ⅠB1期宫颈腺癌患者保留卵巢的风险及预后。方法:回顾性分析1994年8月至2015年4月北京大学第一医院妇产科收治的139例ⅠB1期浸润性宫颈癌的临床资料,其中宫颈腺癌38例、宫颈鳞癌101例,按是否保留卵巢分为两组,分析比较卵巢转移的风险及保留卵巢的预后。结果:38例ⅠB1期宫颈腺癌的平均5年累计生存率为89.1%,101例同期宫颈鳞癌为92.9%,两组相比差异有统计学意义(P=0.034)。宫颈腺癌患者中32例行卵巢切除,病理证实的卵巢转移率为3.1%(1/32),而宫颈鳞癌患者中54例行卵巢切除,病理证实的卵巢转移率为1.8%(1/54),两组间差异无统计学意义(P=0.574)。宫颈腺癌中6例保留卵巢患者的平均5年累计生存率为80.1%,而宫颈鳞癌中47例保留卵巢患者的平均5年累计生存率为94.6%(P=0.127),两组间的生存曲线差异无统计学意义。结论:ⅠB1期宫颈腺癌相比同期的宫颈鳞癌预后稍差,但对于年轻的、无明显高危因素的ⅠB1期宫颈腺癌患者可以考虑保留卵巢。

Objective： To analyze the risk and prognostic of patients with stage ⅠB1 cervical adenocarcinoma. Methods： The clinical data of 139 patients with stage ⅠB1 cervical adenocarcinoma treated at Department of Gynecology and Obstetrics in Peking University First Hospital from August 1994 to April2015 were retrospectively reviewed,which included 38 cases of cervical adenocarcinoma and 101 cases of cervical squamous cell carcinoma. A comparison was made between ovarian preserving group and bilateral oophorectomy group,in order to justify the risk and prognosis of ovarian preserving patients. Results：The 5-year cumulative survival rate of stage ⅠB1 cervical adenocarcinoma and squamous cell carcinoma were 89. 1% and 92. 9% respectively with significant difference（ P = 0. 034）. One ovarian metastasis case was observed among the 32 cervical adenocarcinoma patients of bilateral oophorectomy,while another ovarian metastasis case was observed among 54 cervical squamous cell carcinoma patients of bilateral oophorectomy. The ovarian metastasis rate was 3. 1%（ 1 /32） and 1. 8 %（ 1 /54） respectively with no statistical difference（ P = 0. 574）. The cumulative 5-year survival of 6 ovarian preserving patients with cervical adenocarcinoma was 80. 1%,while that of 47 ovarian preserving patients with cervical squamous cell carcinoma was 94. 6%（ P = 0. 127）. There was no statistical difference between the survival curve of the two groups. Conclusion： The prognosis of stageⅠB1 cervical adenocarcinomas was somewhat poorer than that of cervical squamous cell carcinoma. However it was still reasonable to perform ovarian preservation among young patients of stageⅠB1 cervical adenocarcinoma with no high risk factors.