Glaze Sarah, Duan Qiuli, Sar Aylin, Lee Sandra, Köbel Martin, Park Elena, Duggan Máire A
Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB.
Research Facilitation, Alberta Health Services, Calgary, AB.
J Obstet Gynaecol Can. 2019 Sep;41(9):1318-1324. doi: 10.1016/j.jogc.2019.01.026. Epub 2019 Apr 19.
This study aimed to identify clinical and pathological determinants of invasive adenocarcinoma of the uterine cervix (AC) in a large, single-centre series serving a population of 1.5 million.
Data on clinical (n = 27) and pathological (n = 23) variables for 166 women with a diagnosis of AC treated between 2000 and 2013 were extracted from their charts and pathology reports. Overall survival (OS) was calculated, and significant determinants were identified using Kaplan-Meier analyses and log-rank tests, respectively (Canadian Task Force Classification II-2).
This was a heterogeneous group of women with all stages of disease treated with conization, surgery, radiation, and systemic chemotherapy, alone or in combination. Mean age at diagnosis was 43; 86.7% had stage I disease, 9.6% had stage II, and only 3.6% had stage III and IV disease. Mean follow-up was 108 months. Many histotypes were diagnosed and grouped as mucinous (n = 103), endometrioid (n = 15), rare (n = 9), and adenosquamous (n = 39) types. Twenty-eight women had recurrent cancer and died of the disease; OS at 5 years was 85%. Five-year OS for women with stage I was 92%, compared with 40% for stage II or higher. Univariate analysis revealed that premenopausal status, tumour size, first-line treatment with chemotherapy, lymphovascular invasion, rare histological subtypes, stage, and receipt of second-line treatment were all significantly associated with a lower OS. Using multivariate analysis, only stage remained an independent factor.
This is the largest single-centre Canadian series of invasive AC. Stage is the strongest prognostic factor in multivariate analysis; in contrast to other studies, lymph node status was not a significant determinant.
本研究旨在确定在一个服务于150万人口的大型单中心队列中子宫颈浸润性腺癌（AC）的临床和病理决定因素。
从166例在2000年至2013年间被诊断为AC的女性患者的病历和病理报告中提取临床（n = 27）和病理（n = 23）变量的数据。计算总生存期（OS），并分别使用Kaplan-Meier分析和对数秩检验确定显著的决定因素（加拿大工作组分类II-2）。
这是一组异质性女性患者，疾病各阶段均接受了锥切术、手术、放疗和全身化疗，单独或联合使用。诊断时的平均年龄为43岁；86.7%为I期疾病，9.6%为II期，只有3.6%为III期和IV期疾病。平均随访时间为108个月。诊断出多种组织学类型，并分为黏液性（n = 103）、子宫内膜样（n = 15）、罕见型（n = 9）和腺鳞癌（n = 39）类型。28名女性出现癌症复发并死于该疾病；5年总生存率为85%。I期女性的5年总生存率为92%，而II期或更高分期的女性为40%。单因素分析显示，绝经前状态、肿瘤大小、一线化疗、淋巴管浸润、罕见组织学亚型、分期和接受二线治疗均与较低的总生存率显著相关。多因素分析显示，只有分期仍然是一个独立因素。
这是加拿大最大的单中心浸润性AC系列研究。在多因素分析中，分期是最强的预后因素；与其他研究不同，淋巴结状态不是一个显著的决定因素。
