Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Gynecol Oncol. 2012 Oct;127(1):114-20. doi: 10.1016/j.ygyno.2012.06.021. Epub 2012 Jun 21.
To evaluate the significance of adenocarcinoma (AC) compared with squamous cell carcinoma (SCC) with regard to the survival of surgically-treated early stage cervical cancer patients.
We retrospectively reviewed the medical records of 520 patients with FIGO stage IA2-IIB cervical cancer who were treated with radical hysterectomy with or without adjuvant radiotherapy between January 1998 and December 2008. The patients were classified according to (i) pathological risk factors (low-, intermediate-, or high-risk group) and (ii) adjuvant radiotherapy (concurrent chemoradiotherapy [CCRT group] or radiotherapy alone [RT group]). Survival outcomes were examined by Kaplan-Meier method and compared with Log-rank test. Multivariate analysis for disease-specific survival (DSS) was performed using Cox proportional hazards regression model to investigate the prognostic significance of histological subtype.
AC histology was associated with significantly decreased DSS compared with SCC histology in the intermediate- and high-risk groups (hazard ratio: 3.06 and 2.88, respectively, both P<0.05) while there was no survival difference in the low-risk group (P=0.1). Among patients who received any types of adjuvant radiotherapy, DSS of AC histology patients were significantly poorer than SCC histology. Multivariate analysis demonstrated AC histology to be an independent predictor of decreased DSS in both CCRT and RT groups. Moreover, pelvic nodal metastasis significantly predicted the poor survival of patients with AC histology who received CCRT in multivariate analysis
Adenocarcinoma is an independent prognostic indicator of poor survival in early stage cervical cancer patients with intermediate- and high-risk factors, regardless of the type of adjuvant radiotherapy after radical hysterectomy.
评估腺癌（AC）与鳞癌（SCC）在手术治疗早期宫颈癌患者生存方面的意义。
我们回顾性分析了 1998 年 1 月至 2008 年 12 月期间接受根治性子宫切除术加或不加辅助放疗的 520 例 FIGO 分期 IA2-IIB 宫颈癌患者的病历。患者根据（i）病理危险因素（低、中、高危组）和（ii）辅助放疗（同期放化疗[CCRT 组]或单纯放疗[RT 组]）进行分类。采用 Kaplan-Meier 法和 Log-rank 检验比较生存结果。采用 Cox 比例风险回归模型进行多因素分析，以探讨组织学亚型对疾病特异性生存（DSS）的预后意义。
AC 组织学与中高危组 SCC 组织学相比，DSS 显著降低（危险比分别为 3.06 和 2.88，均 P<0.05），而低危组无生存差异（P=0.1）。在接受任何类型辅助放疗的患者中，AC 组织学患者的 DSS 明显差于 SCC 组织学。多因素分析表明，AC 组织学是 CCRT 和 RT 组 DSS 降低的独立预测因素。此外，多因素分析表明，盆腔淋巴结转移是接受 CCRT 的 AC 组织学患者生存不良的独立预测因素。
在接受根治性子宫切除术加辅助放疗的中高危早期宫颈癌患者中，腺癌是生存不良的独立预后指标，与辅助放疗的类型无关。
