Fregnani José H T G, Soares Fernando A, Novik Pablo R, Lopes Ademar, Latorre Maria R D O
Morphology Department of the School of Medical Sciences of Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, CEP 01221-020 São Paulo, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2008 Feb;136(2):215-23. doi: 10.1016/j.ejogrb.2006.10.021. Epub 2006 Nov 27.
(1) To compare the anatomopathological variables and recurrence rates in patients with early-stage adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the uterine cervix; (2) to identify the independent risk factors for recurrence.
This historical cohort study assessed 238 patients with carcinoma of the uterine cervix (IB and IIA), who underwent radical hysterectomy with pelvic lymph node dissection between 1980 and 1999. Comparison of category variables between the two histological types was carried out using the Pearson's chi(2)-test or Fisher exact test. Disease-free survival rates for AC and SCC were calculated using the Kaplan-Meier method and the curves were compared using the log-rank test. The Cox proportional hazards model was used to identify the independent risk factors for recurrence.
There were 35 cases of AC (14.7%) and 203 of SCC (85.3%). AC presented lower histological grade than did SCC (grade 1: 68.6% versus 9.4%; p<0.001), lower rate of lymphovascular space involvement (25.7% versus 53.7%; p=0.002), lower rate of invasion into the middle or deep thirds of the uterine cervix (40.0% versus 80.8%; p<0.001) and lower rate of lymph node metastasis (2.9% versus 16.3%; p=0.036). Although the recurrence rate was lower for AC than for SCC (11.4% versus 15.8%), this difference was not statistically significant (p=0.509). Multivariate analysis identified three independent risk factors for recurrence: presence of metastases in the pelvic lymph nodes, invasion of the deep third of the uterine cervix and absence of or slight inflammatory reaction in the cervix. When these variables were adjusted for the histological type and radiotherapy status, they remained in the model as independent risk factors.
The AC group showed less aggressive histological behavior than did the SCC group, but no difference in the disease-free survival rates was noted.
（1）比较早期子宫颈腺癌（AC）和鳞状细胞癌（SCC）患者的解剖病理学变量及复发率；（2）确定复发的独立危险因素。
这项历史性队列研究评估了1980年至1999年间接受根治性子宫切除术及盆腔淋巴结清扫术的238例子宫颈癌（IB和IIA期）患者。使用Pearson卡方检验或Fisher精确检验对两种组织学类型的分类变量进行比较。采用Kaplan-Meier法计算AC和SCC的无病生存率，并使用对数秩检验比较曲线。采用Cox比例风险模型确定复发的独立危险因素。
有35例AC（14.7%）和203例SCC（85.3%）。AC的组织学分级低于SCC（1级：68.6%对9.4%；p<0.001），淋巴管间隙浸润率较低（25.7%对53.7%；p=0.002），子宫颈中或深部浸润率较低（40.0%对80.8%；p<0.001），淋巴结转移率较低（2.9%对16.3%；p=0.036）。虽然AC的复发率低于SCC（11.4%对15.8%），但差异无统计学意义（p=0.509）。多变量分析确定了三个复发的独立危险因素：盆腔淋巴结转移、子宫颈深部浸润以及子宫颈无或轻度炎症反应。当对这些变量进行组织学类型和放疗状态调整后，它们仍作为独立危险因素保留在模型中。
AC组的组织学行为比SCC组的侵袭性小，但无病生存率无差异。
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