子宫颈非鳞状细胞癌的临床特征及预后分析

Clinical Features and Prognosis Analysis of Non-squamous Cell Carcinoma of the Uterine Cervix

目的:比较不同病理类型的子宫颈非鳞状细胞癌(UCNS)的临床特征及预后,分析影响UCNS癌预后的危险因素。方法:回顾性分析青岛大学附属医院2004年3月至2019年3月初次治疗的295例ⅠA2~ⅡA2期(2009 FIGO) UCNS患者的临床资料,比较分析244例子宫颈腺癌(AC组)、29例子宫颈腺鳞癌(ASC组)、16例子宫颈神经内分泌癌(NEC组)和6例子宫颈透明细胞癌(CCC组)的临床特征,295例患者中242例随访信息完整,其中AC组197例,ASC组24例,NEC组15例、CCC组6例,比较分析其预后。结果:(1)4组患者在术前术后病理相符、肿瘤分化、脉管浸润、FIGO分期、辅助治疗方面比较,差异均有统计学意义(P <0.05);(2)AC组、ASC组、NEC组、CCC组5年总体生存率(OS)分别为76.20%、75.80%、58.00%、100.00%,4组间差异无统计学意义;产次> 2次、肿瘤最大直径> 4 cm、子宫颈浸润深度> 1/2、脉管癌栓浸润、宫旁浸润、淋巴结转移、不同辅助治疗方案与子宫颈非鳞癌预后有关;(3)Cox回归多因素分析得出子宫颈深肌层浸润、宫旁浸润、淋巴结转移是影响UCNS患者预后的独立危险因素。结论:不同病理类型的UCNS患者的临床特征及预后有所差异,针对不同病理类型的患者在诊疗方面需给予个体化方案,临床上应引起重视。

Objective: To compare the clinical features and prognosis of different pathologic types of cervical non-squamous cell carcinoma( UCNS),to analyse risk factors and affect the prognosis. Methods: We retrospectively accessed clinical data of 295 patients with ⅠA2-ⅡA2( 2009 FIGO) UCNS,including 244 patients with cervical adenocarcinoma( AC group),29 patients with cervical adenosquamous carcinoma( ASC group),16 patients with cervical neuroendocrine carcinoma( NEC group) and 6 patients with cervical clear cell carcinoma( CCC group) who were initially treated at Affiliated Hospital of Qingdao University from March 2004 to March 2019. And we compared and analyzed the prognosis of 242 patients with complete follow-up information,including 197 cases of AC group,24 cases of ASC group,15 cases of NEC group and 6 cases of CCC group. Results:(1)There were statistically significant differences in preoperative and postoperative pathological consistency,degree of tumor differentiation,vascular tumor thrombus infiltration,FIGO staging and adjuvant therapy among the 4 groups( P <0. 05).(2)The 5-year overall survival rate( OS) of the 4 groups were 76. 20%,75. 80%,58. 00% and 100. 00%.Respectively,there was no significant difference among the 4 groups. Delivery times > 2 times,tumor size > 4 cm,the depth of cervical infiltration > 1/2,vascular tumor thrombus infiltration,parametrial infiltration,lymph node metastasis,and adjuvant treatment were the factors affecting the prognosis of UCNS.(3)On Cox regression multivariate analysis,deep muscular infiltration of the cervix,parametrial infiltration and lymph node metastasis were independent risk factors of poor prognosis. Conclusions: Different pathological subtypes of uterine cervical non-squamous cell carcinoma have different clinical features and prognosis. Individualized treatment plans should be given for patients with different pathological subtypes,and attention should be emphasized clinically.