Jung Eun Jung, Byun Jung Mi, Kim Young Nam, Lee Kyung Bok, Sung Moon Su, Kim Ki Tae, Jeong Dae Hoon
*Department of Obstetrics and Gynecology, and †Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan, South Korea.
Int J Gynecol Cancer. 2017 Jul;27(6):1228-1236. doi: 10.1097/IGC.0000000000001009.
We aimed to analyze the differences in prognosis and the pattern of recurrence between squamous cell carcinoma (SCC) and adenocarcinoma (ADC) in patients with cervical cancer.
We retrospectively reviewed the medical records of 969 patients with SCC and 144 patients with ADC who underwent radical hysterectomy and pelvic lymph node dissection at the Busan Paik Hospital between January 1988 and December 2010.
Adenocarcinoma was associated with poorer disease-free survival (P = 0.0515) and overall survival (OS) (P = 0.0156) compared with SCC, and that this was more apparent for patients with International Federation of Gynecology and Obstetrics stages IIA to IIB disease. Subgroup analysis by prognostic factors for recurrence showed significant differences in the OS in the intermediate-risk subgroup (P = 0.0266), but not in the high-risk subgroup (P = 0.1674). Based on the metastatic pattern in patients with recurrence, ADC was associated with an increased risk for distant recurrence resulting from hematogenous spread compared with SCC (P < 0.0001), and patients with distant recurrence showed a worse OS (P = 0.0481) and survival after recurrence (P = 0.0016) than patients with locoregional or lymphatic recurrence. Multivariate analysis showed that ADC was a significant independent factor for poor disease-free survival (P = 0.0034) and OS (P = 0.0001).
Adenocarcinoma is associated with a poorer prognosis and a greater probability of distanat recurrence compared with SCC. Different therapeutic strategies for ADC need to be developed, and when considering the greater tendency for distant recurrence in patients with ADC, systemic chemotherapy may have a role in reducing the risk of hematogenous spread.
我们旨在分析宫颈癌患者中鳞状细胞癌（SCC）和腺癌（ADC）在预后及复发模式上的差异。
我们回顾性分析了1988年1月至2010年12月期间在釜山白医院接受根治性子宫切除术和盆腔淋巴结清扫术的969例SCC患者和144例ADC患者的病历。
与SCC相比，腺癌的无病生存率（P = 0.0515）和总生存率（OS）（P = 0.0156）较差，对于国际妇产科联盟IIA至IIB期疾病的患者，这种情况更为明显。按复发预后因素进行的亚组分析显示，中危亚组的OS有显著差异（P = 0.0266），但高危亚组无显著差异（P = 0.1674）。基于复发患者的转移模式，与SCC相比，ADC因血行播散导致远处复发的风险增加（P < 0.0001），远处复发患者的OS（P = 0.0481）和复发后生存率（P = 0.0016）比局部区域或淋巴复发患者更差。多因素分析显示，ADC是无病生存率差（P = 0.0034）和OS差（P = 0.0001）的显著独立因素。
与SCC相比，腺癌的预后较差，远处复发的可能性更大。需要制定针对ADC的不同治疗策略，并且考虑到ADC患者远处复发的趋势更大，全身化疗可能在降低血行播散风险方面发挥作用。
