178例宫颈腺癌临床病理特征与预后分析

Clinicopathological characteristics and prognosis of 178 cases of cervical adenocarcinoma

目的探讨济宁地区宫颈腺癌的临床病理特征,并分析患者预后。方法收集2012年1月至2021年12月济宁医学院附属医院收治的宫颈腺癌患者178例,回顾性分析宫颈腺癌的临床病理特征,电话随访患者生存状态,采用Kaplan-Meier生存分析和Cox回归方法对宫颈腺癌患者进行预后分析。结果178例患者年龄23~81岁,平均(47±10)岁,发病年龄主要集中在41~50岁,大部分患者为超重或肥胖患者,且以农民为主,主要以阴道出血[59.0%(105/178)]为主诉就诊。病理学类型以普通腺癌[56.7%(101/178)]为主,其次为原位腺癌[19.1%(34/178)]、特殊类型腺癌[18.5%(32/178)]和腺鳞癌[6.2%(11/178)]。FIGOⅠ期患者占86.0%(153/178),大部分患者宫颈有肿物,浸润深度>1/2宫颈肌层占37.6%(67/178),淋巴结转移阳性率为12.9%(23/178)。178例宫颈腺癌成功随访率为99.4%(177/178),总生存率为87%(154/177),1年、3年和5年生存率为89.3%(158/177)、57.6%(102/177)和37.8%(67/177)。Kaplan-Meier生存分析显示诊断年龄(P=0.001)、流产次数(P=0.007)、人乳头瘤病毒(HPV)感染(P<0.001)、FIGO分期(P<0.001)、肿物大小(P=0.040)、浸润深度(P<0.001)、分化程度(P=0.003)和淋巴结转移(P<0.001)与患者预后密切相关;多因素Cox回归显示浸润深度(χ^(2)=4.538,P=0.033)和淋巴结转移(χ^(2)=8.701,P=0.003)是宫颈腺癌的独立预后因素。结论济宁地区宫颈腺癌发病率较高,具有独特的临床病理特征,肿瘤浸润深度和淋巴结转移是宫颈腺癌的独立预后因素。

【Objective】To investigate the clinicopathological characteristics of cervical adenocarcinoma(CA)in Jining area and analyze the prognosis of patients.【Methods】A toal of 178 cases of cervical adenocarcinoma in the Affiliated Hospital of Jining Medical College were collected from January 2012 to December 2021.The clinicopathological characteristics of CA were analyzed retrospectively.The survival status of patients was followed up by telephone.The prognosis of CA patients was analyzed by Kaplan-Meier survival analysis and Cox regression.【Results】The average age of 178 patients was 47±10 years(range:23–81 years).The onset age was mainly between 41–50 years old.Most of the patients were overweight or obese.And most of them were farmers.59.0%(105/178)of CA patients complained of vaginal bleeding.The main pathological types were ordinary adenocarcinoma 56.7%(101/178),followed by adenocarcinoma in situ 19.1%(34/178),special type adenocarcinoma 18.5%(32/178)and adenosquamous carcinoma 6.2%(11/178).86.0%(153/178)of FIGO stage I patients had cervical tumors,37.6%(67/178)of them had infiltration depth>1/2 of cervical muscle layer,and the positive rate of lymph node metastasis was 12.9%(23/178).The successful follow-up rate of 178 cases of CA was 99.4%(177/178),the overall survival rate was 87%(154/177).Moreover,the 1-year,3-year and 5-year survival rates were 89.3%(158/177),57.6%(102/177)and 37.8%(67/177),respectively.Kaplan-Meier survival analysis showed that diagnosis age(P=0.001),number of abortions(P=0.007),HPV infection(P<0.001),FIGO stage(P<0.001),tumor size(P=0.040),depth of invasion(P<0.001),degree of differentiation(P=0.003)and lymph node metastasis(P<0.001)were closely related to the prognosis of patients;Cox regression shows infiltration depth(χ^(2)=4.538,P=0.033)and lymph node metastasis(χ^(2)=8.701,P=0.003)were independent prognostic factors of cervical adenocarcinoma.【Conclusion】The incidence rate of CA with unique clinicopathological characteristics is high in Jining area,and the depth of tumor invasion and lymph node metastasis were independent prognostic factors of cervical adenocarcinoma.