宫颈微偏腺癌临床病理及预后因素分析

The clinicopathological features and prognostic factors in patients with cervical micro-adenocarcinoma

目的探讨宫颈微偏腺癌(MDA)的临床病理特点及预后相关因素,为更好治疗MDA提供依据。方法回顾性分析2003年1月至2018年6月治疗的25例MDA患者的临床病理资料,随访其生存状况,分析预后因素。结果本组MDA患者平均年龄44.1岁(31~69岁),确诊时Ⅱb期及以后占32%;临床主要表现为阴道排液增多,伴不规则流血,宫颈肥大、质硬。病理特征为大量黏液腺体浸润宫颈深肌层,深部血管及神经组织见腺体浸润。免疫组化:CEA(56%+)、Ki-67(36%+)、p53(28%+)、CA125(28%+),ER及PR均为阴性;术后病理:淋巴结阳性8例,LVSI阳性9例,4例行术后化疗,11例行同步放化疗,8例直接行根治性放疗。25例随访11~71个月,中位数为46个月。随访期内15例因MDA死亡,占60.0%,1年生存率为92.0%,3年生存率为72.0%,5年生存率为12.0%;单因素分析显示:肿瘤分期(P=0.000)、手术方式(P=0.002)、有无淋巴结转移(P=0.002)、LVSI(P=0.001)对MDA患者的生存率有影响。多因素分析显示:肿瘤分期(P=0.007)、有无淋巴结转移(P=0.031)、LVSI(P=0.045)是影响MDA患者生存预后的危险因素。结论MDA临床表现不典型,确诊需依靠病理学,预后影响因素较多,临床上应尽可能早期诊断,采取综合治疗,改善MDA患者的预后。

Objective To investigate the clinicopathological features and prognostic factors in patients with cervical micro-adenocarcinoma(MDA),so as to provide basis for better treatment of MDA.Methods The clinicopathological features of 25 patients with MDA who were treated in our hospital from January 2003 to June 2018 were retrospectively analyzed.The survival status was followed up and prognostic factors were analyzed.Results The average age of patients with MDA was 44.1 years(31~69 years),and the cases with IIb accounted for 32%.The main clinical manifestations were increased vaginal discharge,irregular bleeding,hypertrophy of the cervix and hard mass.The pathological features were a large number of mucous glands infiltrating the deep deep muscle layer of the cervix,and deep blood vessels and nerve tissues see glandular infiltration.Immunohistochemistry results:CEA(56%+),Ki-67(36%+),p53(28%+),CA125(28%+),ER and PR were negative.The postoperative pathology results:there were 8 cases of positive lymph node,9 cases of positive LVSI,and 4 cases received postoperative chemotherapy,11 cases received concurrent radiotherapy and chemotherapy,and 8 cases underwent radical radiotherapy.Moreover 25 patients were followed up for 11~71 months,with median being 46 months.During the follow-up,15 patients died of MDA,accounting for 60.0%,and 1-year survival rate was 92.0%,3-year survival rate was 72.0%,and 5-year survival rate was 12.0%.Univariate analysis showed that the tumor stage,surgical procedure,,lymph node metastasis and LVSI were the influencing factors on the survival rate of patients.Multivariate analysis showed that tumor stage,lymph node metastasis and LVSI were risk factors for survival prognosis of patients.The follow up results showed that 15 cases were died from cervical carcinoma,accounted for 60.0%.Conclusion The clinical manifestations of MDA are atypical,and its diagnosis depends on pathology.There are many factors influencing the prognosis of patients.Clinically,it is necessary to diagnose as early as possible,and to take comprehensive treatment so as to improve the prognosis of patients.