宫颈绒毛状腺癌33例临床分析

Villoglandular adenocarcinoma of uterine cervix:Clinical analysis of 33 cases

目的探讨宫颈绒毛状腺癌(VGA)的临床治疗及预后情况。方法回顾性分析2005年1月至2021年1月诊治的33例宫颈VGA患者的临床表现、治疗方法和预后情况。结果33例患者的中位发病年龄为45岁(范围:28~73岁)。最常见的临床表现为宫颈接触性出血和阴道不规则流血。多数患者伴人乳头瘤病毒(HPV)感染,以HPV16型和18型为主。根据宫颈癌FIGO 2018版分期系统:IB期12例、IB期9例、IB期1例、ⅡA期3例、ⅡA期1例、ⅡB期1例、ⅢB期3例、ⅢC期2例、ⅢC期1例。28例患者行根治性子宫/子宫颈±双附件/输卵管切除术+盆腔淋巴结清扫术±腹主动脉旁淋巴结切除术,5例患者行根治性放化疗。28例手术患者中,术后病理显示,仅5例宫颈肌层浸润深度≥1/2,1例同时存在盆腔淋巴结及腹主动脉旁淋巴结转移,2例存在盆腔淋巴结转移,4例存在淋巴脉管间隙浸润。随访截止于2021年5月,中位随访45.3个月(范围:10~108个月),4例失访,4例复发(其中3例死亡),25例(包括保留卵巢的7例)存活且肿瘤无复发。结论宫颈VGA发病率较低,其发生与HPV感染有关。淋巴脉管间隙浸润、卵巢转移及淋巴结转移少见,预后较好。

Objective To investigate the clinical treatment and prognostic of villoglandular adenocarcinoma( VGA) of uterine cervix. Methods The data of clinical presentation,management,and prognosis of 33 patients with cervical VGA from January 2005 to January 2021 were retrospectively reviewed. Results The median age of 33 patients was 45 years ( ranged from 28 to 73 years) . The most common clinical manifestations were cervical contact bleeding and irregular vaginal bleeding. Most patients were accompanied with human papilloma virus( HPV) infection,mainly HPV16 type and 18 type. According to the FIGO staging system of cervical cancer in2018,12 cases of stage IB,9 cases of stage IB,1 case of stage IB,3 cases of stage ⅡA,1 case of stage ⅡA,1 case of stage ⅡB,3 cases of stage ⅢB,2 cases of stage ⅢCand 1 case of stage ⅢC. Tewnty-eight patients underwent radical uterus / cervix ± double appendages / salpingectomy + pelvic lymphadenectomy±paraaortic lymphadenectomy,and 5 patients underwent radical radiotherapy and chemotherapy. Of the 28 patients who underwent surgery,only 5 had cervical myometrial invasion depth ≥ 1 /2,1 had pelvic lymph node and paraaortic lymph node metastasis,2 had pelvic lymph node metastasis,and 4 had lymphatic vessel space infiltration. The median follow-up period was 45. 3 months ( ranged from 10 to 108 months) until May 2021. Four patients were lost follow-up,four patients relapsed ( 3 of them died) ,and 25 patients ( including 7 patients with preserved ovaries) survived without tumor recurrence.Conclusion Cervical VGA has a low incidence rate,which is associated with HPV infection. Lymphatic vessel space infiltration,ovarian metastasis and lymph node metastasis are rare,and the prognosis is good.