Yang Li, Zheng Aiwen, Zhang Xiang, Fang Xianhua, Sun Wenyong, Chen Yaqing
Departments of *Gynecologic Oncology, and †Pathology, Zhejiang Cancer Hospital, Hangzhou, China.
Int J Gynecol Cancer. 2017 Jun;27(5):1009-1014. doi: 10.1097/IGC.0000000000000992.
The aim of this study was to summarize the clinical and pathological characteristics and to conduct prognosis analysis of patients who were diagnosed with clear cell carcinoma of the uterine cervix (CCCUC) and without a history of exposure to diethylstilbestrol.
We performed a retrospective review of all the patients with CCCUC who were diagnosed and treated at Zhejiang Cancer Hospital between 1998 and 2014. Charts were reviewed for clinical and pathological characteristics, and prognosis analysis was conducted.
A total of 47 patients were included. Median age was 52 years. No patient had a history of exposure to diethylstilbestrol. The International Federation of Gynecology and Obstetrics stage distribution was 55.3% (n = 26) stage I, 40.4% (n = 19) stage II, 2.1% (n = 1) stage III, and 2.1% (n = 1) stage IV. Forty-two patients (89.4%) underwent radical hysterectomy and pelvic lymphadenectomy. Pathological examination revealed deep cervical stromal invasion (greater than two thirds) in 20 patients (48.4%), pelvic lymph node (PLN) metastasis in 10 patients (23.8%), lymphovascular space involvement in 9 patients (21.4%), and ovarian metastasis in 1 patient (2.4%). Advanced tumor stage (IIB-IV), larger tumor size (>4 cm), and PLN metastasis had negative effects on progression-free survival (PFS) and overall survival (OS) (P < 0.05). Adjuvant radiation therapy alone or concurrent chemoradiation therapy after radical surgery did not affect PFS or OS in patients with risk factors (P > 0.05).
International Federation of Gynecology and Obstetrics stage, tumor size, and PLN status were prognostic factors for both PFS and OS in patients with CCCUC. The long-term effects of adjuvant radiation therapy or concurrent chemoradiation therapy may be limited for CCCUC patients with risk factors. Future larger case series or clinical trials are required to confirm these findings.
本研究旨在总结无己烯雌酚暴露史的子宫颈透明细胞癌（CCCUC）患者的临床和病理特征，并进行预后分析。
我们对1998年至2014年期间在浙江省肿瘤医院诊断和治疗的所有CCCUC患者进行了回顾性研究。查阅病历以获取临床和病理特征，并进行预后分析。
共纳入47例患者。中位年龄为52岁。所有患者均无己烯雌酚暴露史。国际妇产科联盟（FIGO）分期分布为：I期占55.3%（n = 26），II期占40.4%（n = 19），III期占2.1%（n = 1），IV期占2.1%（n = 1）。42例患者（89.4%）接受了根治性子宫切除术和盆腔淋巴结清扫术。病理检查显示，20例患者（48.4%）有宫颈深部间质浸润（超过三分之二），10例患者（23.8%）有盆腔淋巴结转移，9例患者（21.4%）有脉管间隙受累，1例患者（2.4%）有卵巢转移。肿瘤晚期（IIB-IV期）、肿瘤较大（>4 cm）和盆腔淋巴结转移对无进展生存期（PFS）和总生存期（OS）有负面影响（P < 0.05）。根治性手术后单独辅助放疗或同步放化疗对有危险因素的患者的PFS或OS无影响（P > 0.05）。
FIGO分期、肿瘤大小和盆腔淋巴结状态是CCCUC患者PFS和OS的预后因素。辅助放疗或同步放化疗对有危险因素的CCCUC患者的长期影响可能有限。需要未来更大规模的病例系列研究或临床试验来证实这些发现。
