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浙江大学学报（医学版）
浙江大学学报（医学版）  2018, Vol. 47 Issue (4): 357-361    DOI: 10.3785/j.issn.1008-9292.2018.08.05
专题报道     
237例宫颈腺癌及腺鳞癌患者临床特征及预后分析
陈倩(),刘露,张静静,韩赛,崔保霞,张友忠*(),孔北华
山东大学齐鲁医院妇产科, 山东 济南 250012
Clinical features and prognosis of cervical adenocarcinoma and adenosquamous carcinoma: an analysis of 237 cases
CHEN Qian(),LIU Lu,ZHANG Jingjing,HAN Sai,CUI Baoxia,ZHANG Youzhong*(),KONG Beihua
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China
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摘要：

目的: 探讨宫颈腺癌和宫颈腺鳞癌患者的临床特征和预后差异。方法: 回顾性分析2007年9月至2016年9月因ⅠB1~ⅡA期宫颈腺癌（201例）或宫颈腺鳞癌（36例）在山东大学齐鲁医院手术治疗患者的临床资料。比较两组的临床特征，并采用Kaplan-Meier生存曲线对两种组织学类型宫颈癌的预后进行评价。结果: 宫颈腺鳞癌组淋巴血管浸润比例较宫颈腺癌组高（P < 0.01），而在年龄、FIGO分期、肿瘤直径、间质浸润深度、宫旁浸润、淋巴结转移和危险分级方面两组差异均无统计学意义（均P>0.05）。宫颈腺癌组和宫颈腺鳞癌组患者5年总存活率分别为79.4%和78.3%，5年无复发存活率分别为77.4%和73.0%，组间差异均无统计学意义（均P>0.05）。术后接受同步放射治疗和化疗的患者中，5年总存活率分别为71.0%和61.4%，5年无复发存活率分别为68.8%和61.1%，组间差异均无统计学意义（均P>0.05）。结论: 宫颈腺鳞癌较宫颈腺癌更易发生淋巴血管浸润，但两者的预后相似。
关键词： 宫颈肿瘤/病理学;  癌, 鳞状细胞/病理学;  腺癌/病理学;  肿瘤浸润;  淋巴转移;  存活率;  预后    
Abstract:

Objective: To analyze the clinical features and prognosis of cervical adenocarcinoma (AC) and adenosquamous carcinoma of cervix (ASC). Methods: The clinical data of 237 patients, including 201 cases of AC and 36 cases of ASC (FIGO stage ⅠB1-ⅡA), who underwent surgery in Qilu Hospital between September 2007 and September 2016 were reviewed. Clinical features of two groups were compared, and Kaplan-Meier survival analysis was performed to evaluate the prognosis. Results: A larger proportion of ASC patients had lymphovascular space invasion compared with AC patients (P < 0.01), but no significant differences were observed in the age, FIGO stage, size of tumor, depth of stromal invasion, parametrial invasion, lymphatic metastasis and risk grade between two groups (all P>0.05). The 5-year overall survival rates of AC and ASC groups were 79.4% and 78.3%, and the 5-year recurrence-free survival rates were 77.4% and 73.0%. Among patients received concurrent chemoradiotherapy, the 5-year overall survival rates were 71.0% and 61.4%, and the 5-year recurrence-free survival rates were 68.8% abd 61.1%, respectively. No significant differences were observed in 5-year overall survival rates and recurrence-free survival rates between AC and ASC patients (all P>0.05). Conclusion: Lymphovascular space invasion was more likely to occur in patients with ASC, but there was no significant difference in the prognosis between AC and ASC patients.
Key words: Uterine cervical neoplasms/pathology    Carcinoma, squamous cell/pathology    Adenocarcinoma/pathology    Neoplasm invasiveness    Lymphatic metastasis    Survival rate    Prognosis
收稿日期: 2018-07-03 出版日期: 2018-12-04
:  R737.33  
基金资助: 国家重点研发计划(2016YFC1302900);国家自然科学基金(81572559);山东省重点研究计划(2017CXGC1210);山东省科学技术发展计划(2014GGH218029)
通讯作者: 张友忠     E-mail: 18769781275@163.com;zhangyouzhong@sdu.edu.cn
作者简介: 陈倩(1991-), 女, 硕士研究生, 主要从事宫颈病变的临床研究; E-mail:18769781275@163.com; https://orcid.org/0000-0003-2502-6357
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陈倩
刘露
张静静
韩赛
崔保霞
张友忠
孔北华

引用本文:

陈倩,刘露,张静静,韩赛,崔保霞,张友忠,孔北华. 237例宫颈腺癌及腺鳞癌患者临床特征及预后分析[J]. 浙江大学学报（医学版）, 2018, 47(4): 357-361.

CHEN Qian,LIU Lu,ZHANG Jingjing,HAN Sai,CUI Baoxia,ZHANG Youzhong,KONG Beihua. Clinical features and prognosis of cervical adenocarcinoma and adenosquamous carcinoma: an analysis of 237 cases. J Zhejiang Univ (Med Sci), 2018, 47(4): 357-361.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.08.05    或    http://www.zjujournals.com/med/CN/Y2018/V47/I4/357

[n(%)]
组别 n FIGO分期 肿瘤直径超过4 cm 淋巴血管浸润 间质浸润深度(>1/2) 宫旁浸润 淋巴结转移 危险分级(中高危*)
ⅠB ⅡA
“—”无相关数据.*高危是指出现以下一个或一个以上因素：盆腔淋巴结阳性、宫旁浸润、手术切缘阳性[17]；中危是指出现以下两个或两个以上因素：间质浸润深度大于1/2、淋巴血管浸润阳性、肿瘤直径大于4 cm[18].
宫颈腺癌组 201 166(82.6) 35(17.4) 35(17.4) 25(12.4) 108(53.7) 10(5.0) 50(24.9) 154(76.6)
宫颈腺鳞癌组 36 26(72.2) 10(27.8) 9(25.0) 11(30.6) 25(69.4) 3(8.3) 6(16.7) 28(77.8)
χ2值 — 2.13 1.16 7.78 3.06 0.66 1.14 0.02
P值 — ＞0.05 ＞0.05 ＜0.01 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 1  宫颈腺癌和腺鳞癌患者临床特征分布情况比较
图 1  宫颈腺癌和宫颈腺鳞癌患者的Kaplan-Meier生存曲线
图 2  术后接受同步放射治疗和化疗的宫颈腺癌和宫颈腺鳞癌患者的Kaplan-Meier生存曲线
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