Maddux H R, Varia M A, Spann C O, Fowler W C, Rosenman J G
Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill.
Int J Radiat Oncol Biol Phys. 1990 Sep;19(3):701-6. doi: 10.1016/0360-3016(90)90499-a.
The incidence of cervix cancer in young women appears to be increasing. However, the influence of young age on prognosis remains unknown. There is almost no information on the prognosis of very young women, age 25 years or less, with invasive cervical carcinoma. From April 1969 to June 1987, 40/2195 (1.8%) patients, age 25 years or less, with invasive carcinoma of the uterine cervix were diagnosed, staged, and treated at our institution. Median age was 24.7 years (range 20.7 to 25.9 years). Distribution by FIGO stage was: Stage IA 7 (18%), Stage IB 23 (58%), Stage II 4 (10%), Stage III 4 (10%), and Stage IVA 2 (4%). Thirty-four (85%) patients had squamous cell carcinoma and six (15%) had adenocarcinoma. Treatment consisted of radical hysterectomy for all Stage IA patients, radical hysterectomy with or without bilateral pelvic node dissection for the 12 early Stage IB patients, and radiation with or without surgery for the remaining 11 Stage IB patients and all Stage II-IVA patients. Median follow-up was 122 months (range 13.2-190.6 months). Five-year disease-free survival rates were: Stage IA 100%; Stage IB 54.8%; and Stage II-IVA 13.7%. Five-year disease-free survival for the Stage IB patients with squamous cell carcinoma age 25 years or less was 64.7%, compared with 83% for women of all ages with Stage IB squamous histology treated at our institution. Seven of 23 Stage IB patients suffered regional recurrence only, one a local recurrence only, one a distant recurrence only, and one a combined recurrence. Seventy-five percent of these patients presented with Stage I disease; however, one-third died from their disease. The major site of failure was in the pelvis only. This, coupled with the low risk of long-term serious complications, suggests that more aggressive pelvic therapy may result in improved disease-free survival.
年轻女性宫颈癌的发病率似乎在上升。然而，年轻对预后的影响仍不清楚。几乎没有关于25岁及以下患有浸润性宫颈癌的极年轻女性预后的信息。1969年4月至1987年6月，在我们机构诊断、分期并治疗了40例年龄在25岁及以下患有子宫颈浸润癌的患者（2195例中的1.8%）。中位年龄为24.7岁（范围20.7至25.9岁）。按国际妇产科联盟（FIGO）分期分布为：IA期7例（18%），IB期23例（58%），II期4例（10%），III期4例（10%），IVA期2例（4%）。34例（85%）患者为鳞状细胞癌，6例（15%）为腺癌。治疗方案为：所有IA期患者行根治性子宫切除术；12例早期IB期患者行根治性子宫切除术，伴或不伴双侧盆腔淋巴结清扫；其余11例IB期患者以及所有II-IVA期患者行放疗，伴或不伴手术。中位随访时间为122个月（范围13.2 - 190.6个月）。五年无病生存率为：IA期100%；IB期54.8%；II-IVA期13.7%。25岁及以下患有鳞状细胞癌的IB期患者的五年无病生存率为64.7%，而在我们机构接受治疗的所有年龄患有IB期鳞状组织学类型的女性这一比例为83%。23例IB期患者中，7例仅发生区域复发，1例仅发生局部复发，1例仅发生远处复发，1例发生联合复发。这些患者中75%初诊时为I期疾病；然而，三分之一患者死于该疾病。主要失败部位仅在盆腔。这一点，再加上长期严重并发症风险较低，表明更积极的盆腔治疗可能会提高无病生存率。
