118例手术治疗的Ⅰb1-Ⅱb期宫颈腺癌患者的临床病理特征及预后

Clinicopathological characteristics and prognosis of 118 cases of cervical adenocarcinoma with stageⅠb1-Ⅱb treated with radical hysterectomy and systematic lymphadenectomy

目的探讨手术治疗的Ⅰb1-Ⅱb期宫颈腺癌患者的临床病理特征及预后。方法收集2003年12月至2015年11月汕头大学医学院附属肿瘤医院收治的118例Ⅰb1-Ⅱb期宫颈腺癌患者的临床资料进行回顾性分析。结果 118例患者诊断时中位年龄46岁,28例为绝经后患者,90例未绝经。Ⅰb1期77例,Ⅰb2期25例,Ⅱa1期4例,Ⅱa2期7例,Ⅱb期5例。卵巢转移率为3.39%。3年无复发生存率81.6%,3年总生存率83.9%,其中Ⅰb1期89.10%,Ⅰb2期73.7%,Ⅱa1期100%,Ⅱa2期83.3%,Ⅱb期60.0%。术后未接受放化疗者、仅接受化疗者、仅接受放疗者和接受放疗+化疗者3年总生存率分别为90.6%、100%、84.6%和70%。多因素Cox比例风险模型的预后分析结果显示:淋巴结转移(P=0.013)、卵巢转移(P=0.001)是影响疾病无进展生存率(PFS)的独立因素。卵巢转移(P<0.001)、深肌层浸润(P=0.032)是影响总生存率(OS)的独立预后因子。结论早中期宫颈腺癌未绝经患者的比例高于绝经后患者,对于年轻的早期患者可在充分评估后保留卵巢。术后合并病理高危因素的患者接受盆腔放疗和化疗能改善生存。

Objective To evaluate the clinicopathological characteristics and prognosis of cervical adenocarcinoma patients with stage Ⅰb1-Ⅱb treated with radical hysterectomy and systematic lymphadenectomy. Methods The clinical,pathologic and followup data of 118 cases of cervical adenocarcinoma with stage Ibl -IIb treated with radical hysterectomy and systematic lymphadenectomy in Cancer Hospital of Shantou University Medical College from Dec. 2003 to Nov. 2015 were analyzed retrospectively. Results 118 patients of cervical adenocarcinoma with stage Ⅰb1-Ⅱb had a median age of 46 years at diagnosis. 28 cases were postmenopausal and 90 cases were premenopausal. There were 77 cases in phase I bl, 25 in stage I b2, 4 in stage Ⅱ a1, 7 in stage Ⅱ a2, 5 in stage Ⅱb. The rate of ovarian metastasis was 3.39%. The 3-year recurrence - free survival rate of the patients was 81.6%. The 3-year overall survival rate of the patients was 83.9% , and 89. 10% for stage Ⅰb1,73. 7% for stage Ⅰ b2,100% for stage Ⅱa1 ,83.3% for stage Ⅱa2,60. 0% for stage Ⅱ b. The 3-year overall survival rates of the patients who receive non-chemoradiotherapy, chemotherapy, radiotherapy and chemoradiotherapy after operation were 90. 6% , 100%, 84. 6% and 70% respectively. The result of Cox proportional hazards regression model analysis indicated that lymph lode metastasis and ovarian metastasis was the independent prognostic factor of desease-free survival, ovarian metastasis and deep myometrial invasion was the independent prognostic factor of overall survival. Conclusions Premenopausal cases are more common than postmenopausal cases in cervical adenocarcinoma with stage Ⅰb1-Ⅱb. Ovarian presevation is feasible for early-stage cervical denocarcinoma after full assessment. Pelvic irradiation with concurrent chemotherapy can lead a better prognosis for the patients with pathological risk factors.