HPV感染与特殊类型宫颈腺癌预后相关性分析

Correlation between HPV infection and prognosis of endocervical adenocarcinoma

目的:本研究将宫颈特殊类型腺癌分为人乳头瘤状病毒(human papillomavirus,HPV)感染相关型和非HPV感染相关型,探讨不同分型与预后的关系。方法:收集美国SEER数据库共468例宫颈特殊类型腺癌患者的临床资料进行回顾性分析,将其分为HPV感染相关型(HPV-associated adenocarcinoma,HPVA)组和非HPV感染相关型(non-HPV-associated adenocarcinoma,NHPVA)组,采用卡方检验、Fisher检验、K-M法、log-rank检验、Cox回归模型进行统计学分析。结果:组间比较结果显示2组患者在分期、肿瘤分化程度方面有明显统计学差异。NHPVA组比HPVA组期别更晚(P=0.001),肿瘤分化更差(P<0.05)。肿瘤相关死亡率在NHPVA组(70/205,34.1%)明显高于HPVA组(53/263,20.2%),NHPVA组总体预后差于HPVA组(P=0.001)。5个病理亚型间预后差异有明显统计学意义(P=0.002),浆液性癌预后最差。结论:基于是否感染HPV对宫颈特殊类型腺癌进行分类能预测患者预后,从而采取相应治疗措施,将对临床工作产生一定指导意义。

Objective:To analyze the prognostic relationship between Human papillomavirus(HPV)-infection and endocervical adenocarcinoma(ECA)of the uterine cervix,so as to provide a reference for clinical work.Methods:Clinical data of 468 ECA patients screened from SEER Database were divided into HPVA(HPV-associated adenocarcinoma)and NHPVA(non-HPV-associated Adenocarcinoma)group,followed by a retrospective analysis,which were statistically analyzed using Chi-square test,Fisher test,K-M method,log-rank test and Cox regression.Results:There were significant differences in stage and tumor differentiation grade between the two groups.Compared with HPVA group,the stage of NHPVA group was later(P=0.001),and the tumor differentiation was worse(P<0.05).The NHPVA group had a significantly higher cancer-related mortality(70/205,34.1%)than HPVA group(53/263,20.2%).The prognosis was significantly worse in NHPVA group than HPVA group(P=0.001).The cancer-related mortality was significantly different(P=0.002)within the 5 sub-groups of mucinous,gastic type,villoglandular,clear cell,and serous carcinoma,while the serous type had the worst prognosis.Conclusion:It is important to classify the ECA into HPVA and NHPVA for clinical work in the future.