Chen R J, Lin Y H, Chen C A, Huang S C, Chow S N, Hsieh C Y
Department of Obstetrics and Gynecology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
Gynecol Oncol. 1999 May;73(2):184-90. doi: 10.1006/gyno.1999.5364.
The aim of this study was to assess survival rates and to evaluate histologic type and age as prognostic factors for cervical carcinoma in an ethnically homogenous population in Taiwan.
A retrospective analysis was conducted of 3678 cases of squamous cell carcinoma and adenocarcinoma that were diagnosed and treated for invasive cervical carcinoma between 1977 and 1994. Observed survival rates were estimated using the Kaplan-Meier method, and prognostic factors were assessed using Cox's proportional hazards regression analysis.
Correlating both FIGO stage and age with histologic type revealed a higher proportion of cases with adenocarcinoma in the lower FIGO stages (P = 0.0417). Further, we found that the younger the age group the higher the proportion of cases of cervical adenocarcinoma (P = 0.0006). The 5-year survival rate was lower for patients with adenocarcinoma than for patients with squamous cell carcinoma (66.5 vs 74.0%, P = 0.0009). The 5-year survival rates for FIGO stages I, II, III, and IV squamous cell carcinoma were 81.3, 75.2, 42.7, and 26.1%, respectively, while for adenocarcinoma they were 75.9, 62.9, 29.2, and 0%, respectively. The difference in survival rates between squamous cell carcinoma and adenocarcinoma was found mainly in stage I (P = 0.0039) and stage II (P = 0.0103), where radiotherapy was used as the primary treatment. Age also affected the overall Kaplan-Meier estimate of survival. The younger the age group, the better the survival rate (P < 0.0001). Multivariate analysis confirmed a highly significant association between survival rate and both histologic type (P < 0.0001) and age (P = 0.0037).
Early stage cervical cancer (stages I and II) with a glandular component had a lower 5-year survival rate than squamous cell carcinoma in cases where radiotherapy was the primary treatment. We speculate that this difference in survival rates between cervical adenocarcinoma and squamous cell carcinoma was due to the relative ineffectiveness of radiotherapy as a primary treatment in cases of adenocarcinoma.
本研究旨在评估台湾一个种族同质人群中子宫颈癌的生存率，并评估组织学类型和年龄作为子宫颈癌预后因素的情况。
对1977年至1994年间诊断并接受治疗的3678例浸润性子宫颈癌鳞状细胞癌和腺癌病例进行回顾性分析。使用Kaplan-Meier方法估计观察到的生存率，并使用Cox比例风险回归分析评估预后因素。
将国际妇产科联盟（FIGO）分期和年龄与组织学类型相关联显示，在较低的FIGO分期中腺癌病例的比例较高（P = 0.0417）。此外，我们发现年龄组越年轻，子宫颈腺癌病例的比例越高（P = 0.0006）。腺癌患者的5年生存率低于鳞状细胞癌患者（66.5%对74.0%，P = 0.0009）。FIGO I、II、III和IV期鳞状细胞癌的5年生存率分别为81.3%、75.2%、42.7%和26.1%，而腺癌的5年生存率分别为75.9%、62.9%、29.2%和0%。鳞状细胞癌和腺癌之间生存率的差异主要在I期（P = 0.0039）和II期（P = 0.0103）发现，在这些阶段放射治疗作为主要治疗方法。年龄也影响了总体Kaplan-Meier生存估计。年龄组越年轻，生存率越好（P < 0.0001）。多变量分析证实生存率与组织学类型（P < 0.0001）和年龄（P = 0.0037）之间存在高度显著的关联。
在以放射治疗为主要治疗方法的情况下，具有腺成分的早期子宫颈癌（I期和II期）的5年生存率低于鳞状细胞癌。我们推测子宫颈腺癌和鳞状细胞癌之间生存率的这种差异是由于放射治疗作为腺癌主要治疗方法的相对无效性。
