高危组织学亚型宫颈癌行根治性子宫切除术患者的结局。
Outcomes of patients undergoing radical hysterectomy for cervical cancer of high-risk histological subtypes.
机构信息
Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
出版信息
Int J Gynecol Cancer. 2011 Jan;21(1):123-7. doi: 10.1097/IGC.0b013e3181ffccc1.
BACKGROUND
The most common types of cervical cancer are squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma, referred to here collectively as SA cervical cancer. Other types of cervical cancer, referred to here collectively as nonsquamous/nonadenocarcinoma (NSNA) cervical cancer, include neuroendocrine, small cell, clear cell, sarcomatoid, and serous tumors. Anecdotally, NSNA tumors seem to have a worse prognosis than their SA counterparts. We sought to determine whether patients with early-stage NSNA have a worse prognosis than those with early-stage SA cervical cancer.
METHODS
We retrospectively reviewed charts of women with stage IA1-IB2 NSNA cervical cancer treated by radical hysterectomy and lymph node staging at M. D. Anderson Cancer Center from 1990 to 2006. The NSNA patients were matched 1:2 to patients with grade 3 SA lesions on the basis of stage, age at diagnosis, tumor size, and date of diagnosis.
RESULTS
Eighteen patients with NSNA primary cervical cancer subtypes (neuroendocrine [n = 7], small cell [n = 5], clear cell [n = 4], papillary serous [n = 1], and sarcomatoid [n = 1]) were matched to 36 patients with grade 3 SA lesions. There were no differences between the 2 groups in age, body mass index, clinical stage, or lesion size. The 2 groups also did not differ with respect to number of nodes resected, lymphovascular space invasion, margin status, lymph node metastasis, or adjuvant radiation therapy or chemotherapy. At a median follow-up of 44 months, median progression-free and overall survivals had not been reached; however, both progression-free survival (P = 0.018) and overall survival (P = 0.028) were worse for the NSNA group. The 5-year progression-free and overall survival rates were 61.2% and 67.6%, respectively, for the NSNA group, compared with 90.1% and 88.3%, respectively, for the SA group.
CONCLUSIONS
Patients with early-stage NSNA cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy have a worse prognosis than patients with grade 3 SA lesions. Patients with NSNA tumors may require a multimodality approach to their cancer care.
背景
最常见的宫颈癌类型是鳞状细胞癌、腺癌和腺鳞癌，这里统称为 SA 宫颈癌。其他类型的宫颈癌，这里统称为非鳞状/非腺癌（NSNA）宫颈癌，包括神经内分泌癌、小细胞癌、透明细胞癌、肉瘤样癌和浆液性肿瘤。据报道，NSNA 肿瘤的预后似乎比其 SA 对应物更差。我们试图确定早期 NSNA 患者的预后是否比早期 SA 宫颈癌患者差。
方法
我们回顾性分析了 1990 年至 2006 年在 M.D.安德森癌症中心接受根治性子宫切除术和淋巴结分期治疗的 IA1-IB2 期 NSNA 宫颈癌患者的病历。根据分期、诊断时的年龄、肿瘤大小和诊断日期，将 NSNA 患者与 3 级 SA 病变患者按 1:2 进行匹配。
结果
18 例 NSNA 原发性宫颈癌亚型患者（神经内分泌癌[n=7]、小细胞癌[n=5]、透明细胞癌[n=4]、乳头状浆液性癌[n=1]和肉瘤样癌[n=1]）与 36 例 3 级 SA 病变患者相匹配。两组在年龄、体重指数、临床分期或病变大小方面无差异。两组在切除的淋巴结数量、脉管间隙浸润、切缘状态、淋巴结转移或辅助放疗或化疗方面也无差异。中位随访 44 个月时，中位无进展生存期和总生存期均未达到；然而，无进展生存期（P=0.018）和总生存期（P=0.028）均为 NSNA 组较差。NSNA 组的 5 年无进展生存率和总生存率分别为 61.2%和 67.6%，而 SA 组分别为 90.1%和 88.3%。
结论
接受根治性子宫切除术和盆腔淋巴结切除术的早期 NSNA 宫颈癌患者的预后比 3 级 SA 病变患者差。NSNA 肿瘤患者可能需要对其癌症治疗采取多模式方法。
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