Lai C.-H., Hsueh S., Hong J.-H., Chang T.-C., Tseng C.-J., Chou H.-H., Huang K.-G., Lin J.-D.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Int J Gynecol Cancer. 1999 Jan;9(1):28-36. doi: 10.1046/j.1525-1438.1999.09895.x.
The aim of this study was to define clinicopathologic features and to investigate prognostic factors in early-stage cervical adenocarcinomas and adenosquamous carcinomas in patients undergoing primary radical surgery. One hundred thirty-four patients with stage IB or II cervical adenocarcinoma or adenosquamous carcinomas treated at a single institution were reviewed and compared to squamous carcinomas (N = 757) treated in the same period. Among adeno-adenosquamous carcinomas, stage II disease, parametrial extension, and deep cervical stromal invasion (>2/3) were associated with increased risk of pelvic lymph node metastases, while only clinical stage II, DNA index >1.3 (by flow cytometry), and pelvic node metastases were significantly associated with decreased survival by multivariate analyses. The five-year recurrence-free and overall survival rates of patients with adeno-adenosquamous vs squamous carcinoma were 72.2% vs 81.2% (P = 0.0109), and 74.1% vs 82.8% (P = 0.0136), respectively by Mantel-Cox test. After controlling confounding factors, histologic type (adeno-adenosquamous vs squamous) was confirmed as an independent prognostic factor for recurrence-free survival [relative risk (RR): 1.2792; 95% confidence interval (CI): 1.0628-1.5399, P = 0.0092) and overall survival (RR: 1.2594, 95% CI: 1.0467-1.5155, P = 0.0146) in the whole series (N = 891). Although pattern of relapse by histologic type was not significantly different, patients with recurrent adeno-adenosquamous carcinoma did significantly worse than those with recurrent squamous carcinoma. In conclusion, the prognosis of adeno-adenosquamous carcinoma of the cervix is slightly worse than squamous tumors. Since salvage of recurrent adeno-adenosquamous carcinoma after primary radical surgery is generally ineffective using conventional treatment, innovative strategies are necessary for the high-risk group after primary surgery and all recurrent adeno-adenosquamous carcinomas regardless of size or site.
本研究的目的是明确临床病理特征，并调查接受原发性根治性手术的早期宫颈腺癌和腺鳞癌患者的预后因素。回顾了在单一机构接受治疗的134例IB期或II期宫颈腺癌或腺鳞癌患者，并与同期治疗的鳞癌患者（N = 757）进行比较。在腺-腺鳞癌中，II期疾病、宫旁组织受累及宫颈深部间质浸润（>2/3）与盆腔淋巴结转移风险增加相关，而多因素分析显示仅临床II期、DNA指数>1.3（通过流式细胞术）及盆腔淋巴结转移与生存率降低显著相关。通过Mantel-Cox检验，腺-腺鳞癌与鳞癌患者的5年无复发生存率分别为72.2%和81.2%（P = 0.0109），总生存率分别为74.1%和82.8%（P = 0.0136）。在控制混杂因素后，组织学类型（腺-腺鳞癌与鳞癌）被确认为整个队列（N = 891）无复发生存率[相对风险（RR）：1.2792；95%置信区间（CI）：1.0628 - 1.5399，P = 0.0092]和总生存率（RR：1.2594，95% CI：1.0467 - 1.5155，P = 0.0146）的独立预后因素。尽管不同组织学类型的复发模式无显著差异，但复发性腺-腺鳞癌患者的情况明显比复发性鳞癌患者差。总之，宫颈腺鳞癌的预后略差于鳞癌。由于原发性根治性手术后复发性腺鳞癌采用传统治疗通常无效，对于原发性手术后的高危组及所有复发性腺鳞癌患者，无论其大小或部位，均需要创新策略。
