HPV相关非破坏性生长的子宫颈腺癌锥切术后患者临床病理特征分析

Clinicopathologic features for residual lesions after cervical conization of HPV-associated endocervical adenocarcinoma with non-destructive growth

目的 评估HPV相关的非破坏性生长的子宫颈腺癌行宫颈锥切术后患者临床病理特征。方法 收集2018年1月至2022年12月绍兴市妇幼保健院行宫颈锥切、后续行子宫切除术或定期随访的非破坏性生长的62例子宫颈腺癌患者临床资料,根据术后是否有病变残留分为病变残留组(13例)和无残留组(49例),分析并比较两组临床病理特征。结果 62例患者年龄25~68(44.9±9.2)岁,其中原位腺癌(AIS)38例,Silva A型腺癌24例;所有患者均为国际妇产科联合会(FIGO)ⅠA期,随访期无病变复发或转移。AIS和Silva A型腺癌在病变范围及象限分布上比较,差异均有统计学意义(均P<0.05)。宫颈锥切后病变残留与年龄(>45岁)、锥切断缘阳性、病灶多象限分布、锥切后颈管搔刮阳性等因素有关(均P<0.05)。结论 HPV相关的AIS和Silva A型腺癌可能处于非破坏性生长的子宫颈腺癌的不同病变阶段且预后良好。锥切后病变残留的影响因素包括年龄(>45岁)、宫颈锥切断缘阳性、病灶多象限分布、锥切后颈管搔刮阳性。无生育要求者建议全子宫切除,但不伴相关影响因素的患者,可制定个体化方案,避免过度治疗。

Objective To evaluate the clinicopathologic features of residual lesions in HPV-associated endocervical adenocarcinoma with non-destructive growth after cervical conization.Methods Sixty-two cases of HPV-associated endocervical adenocar-cinoma with non-destructive growth undergoing cervical conization at Shaoxing Maternal and Children Health Hospital from January 2018 to December 2022 were enrolled in the study.Residual lesions were found in 13 cases during the follow-up,and the clinicopathological features between the residual group(n=13) and the non-residual group(n=49) were compared and the risk factors of residual lesions were analyzed.Results Among 62 patients there were 38 cases of adenocarcinoma in situ(AIS) and 24 cases of Silva A type adenocarcinoma with a mean age of(44.9±9.2) years(25-68).All cases were in FIGO stage Ⅰ A with no recurrence or metastasis during the follow-up period.There were significant differences between AIS and Silva A type adenocarcinoma in lesion range and quadrant distribution(both P<0.05).The residual lesion after cervical conization was associated with the age of patients(>45 years old),the positive margin of conization,the multi-quadrant distribution of lesions,and the positive results of endocervical curettage during conization(all P<0.05).Conclusion HPV-associated AIS and Silva type A adenocarcinomas may be at different stages of endocervical adenocarcinoma with non-destructive growth and good prognosis,however,residual lesions may occur in patients with various risk factors.The study indicates that hysterectomy is recommended for patients without fertility requirements,while for patients without risk factors it is advised to develop a personalized program to avoid overtreatment.