Kumar Sanjeev, Shah Jay P, Bryant Christopher S, Imudia Anthony N, Ali-Fehmi Rouba, Malone John M, Morris Robert T
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, Hutzel Women's Hospital, Wayne State University, 3990 John R, 7 Brush North, Detroit, MI 48201, USA.
Arch Gynecol Obstet. 2009 Jul;280(1):25-32. doi: 10.1007/s00404-008-0851-9. Epub 2008 Nov 29.
To determine the influence of keratinization on prognosis in squamous cell cancer (SCC) of the uterine cervix.
Patients with keratinized squamous cell carcinoma (KSCC) and non-keratinized squamous cell carcinoma (NKSCC) of the cervix were identified from the Limited Use SEER database from 1988 to 2004. A subgroup of patients who did not have radiation or surgery formed the basis to study the natural history of the disease. Data were analyzed using Pearson Chi-square, Student's T tests. Kaplan-Meier and Cox Regression Proportional Hazards survival analysis was conducted in SPSS and SEER-Stat software.
The KSCC group had 3,102 and the NKSCC had 3,751 patients with mean age being 51 and 49 years, respectively (P = 0.001). In general, patients with KSCC were more likely to have advanced stage (FIGO III and IV) disease while patients with NKSCC were more likely to have poorly differentiated neoplasms (P < 0.001). The prevalence of lymph node metastasis remained similar in both histology types (P > 0.05). Overall, the 5-year survival in KSCC was 63.4% as compared to 65.3% in the NKSCC group (P = 0.04). Patients treated by surgery had no difference in survival; however, patients treated by radiation had a median survival in KSCC of 33 months (n = 928, 95% CI 27.7-38.3) as compared to 38 months (n = 1,140, 95% CI 32.1-43.8) in NKSCC (P = 0.03). A total of 165 KSCC and 147 NKSCC patients did not receive treatment. Within this subgroup, the median survival was 10 months (95% CI 5.93-14.07) as compared to 28 months (95% CI 17.9-38.0; P = 0.001) respectively for the two cohorts. In multivariate analysis stage, treatment status, nodal metastasis and keratinization were independent predictors of survival (P < 0.05).
This is the largest study reporting on the prognostic importance of keratinization in SCC. KSCC may be less radiosensitive and associated with shorter overall survival. Also, in the natural history of the SCC, keratinization signifies striking reduction in survival.
确定角化对子宫颈鳞状细胞癌（SCC）预后的影响。
从1988年至2004年的有限使用SEER数据库中识别出子宫颈角化鳞状细胞癌（KSCC）和非角化鳞状细胞癌（NKSCC）患者。一组未接受放疗或手术的患者亚组构成了研究该疾病自然史的基础。使用Pearson卡方检验、学生t检验进行数据分析。在SPSS和SEER-Stat软件中进行Kaplan-Meier和Cox回归比例风险生存分析。
KSCC组有3102例患者，NKSCC组有3751例患者，平均年龄分别为51岁和49岁（P = 0.001）。总体而言，KSCC患者更易出现晚期（国际妇产科联盟III期和IV期）疾病，而NKSCC患者更易出现低分化肿瘤（P < 0.001）。两种组织学类型的淋巴结转移发生率相似（P > 0.05）。总体而言，KSCC的5年生存率为63.4%，而NKSCC组为65.3%（P = 0.04）。接受手术治疗的患者生存率无差异；然而，接受放疗的患者中，KSCC的中位生存期为33个月（n = 928，95%可信区间27.7 - 38.3），而NKSCC为38个月（n = 1140，95%可信区间32.1 - 43.8）（P = 0.03）。共有165例KSCC患者和1
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