Zeng Jing, Jiang Wei, Li Kemin, Zhang Mengpei, Chen Jinghong, Duan Yuanqiong, Li Qingli, Yin Rutie
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, China.
Front Oncol. 2024 Jul 11;14:1430742. doi: 10.3389/fonc.2024.1430742. eCollection 2024.
This study aimed to investigate the clinical and pathological characteristics, treatment strategies, and prognosis of cervical clear cell carcinoma (CCCC) in patients not exposed to diethylstilbestrol .
The patients diagnosed with CCCC at West China Second University Hospital of Sichuan University between January 2011 and Jun 2023 were enrolled for this retrospective study. The clinical characteristics and information on treatment and follow-up were collected. The Kaplan-Meier method and Cox regression analysis were performed to identify the relative variables for predicting progression-free survival (PFS) and overall survival (OS).
Of the 49 patients included, the Federation International of Gynecology and Obstetrics (FIGO) (2018) stage distribution was 37 (75.5%) stage I, 6 (12.2%) stage II, and 6 (12.2%) stage III. The median follow-up interval was 24.1 months. Six (12.2%) patients had a recurrence, and five (10.2%) patients died. The 5-year PFS rate was 86.8%, and the 5-year OS rate was 88.2%. No recurrence or death was detected in two patients who successfully completed fertility-preserving treatment and seven patients who underwent surgery to preserve ovaries. Two patients became pregnant, giving birth to two babies. The univariate analysis showed that FIGO stage, Pelvic lymph node (PLN) metastasis, lymph vascular space invasion, and depth of stromal invasion ( < 0.05) were significantly associated with PFS and OS. However, no significant prognostic factors were identified in the multivariate analysis.
Ovary-preserving treatment and fertility-preserving surgery are safe and feasible in early-stage CCCC. Surveillance other than adjuvant treatment may be a better choice for early-stage CCCC without any pathological risk factors. More targeted therapies and immunotherapy should be pursued in future studies.
本研究旨在探讨未接触己烯雌酚的宫颈透明细胞癌（CCCC）患者的临床和病理特征、治疗策略及预后。
选取2011年1月至2023年6月在四川大学华西第二医院诊断为CCCC的患者进行这项回顾性研究。收集临床特征以及治疗和随访信息。采用Kaplan-Meier法和Cox回归分析来确定预测无进展生存期（PFS）和总生存期（OS）的相关变量。
纳入的49例患者中，国际妇产科联合会（FIGO）（2018年）分期分布为：I期37例（75.5%），II期6例（12.2%），III期6例（12.2%）。中位随访时间为24.1个月。6例（12.2%）患者复发，5例（10.2%）患者死亡。5年PFS率为86.8%，5年OS率为88.2%。成功完成保留生育功能治疗的2例患者和接受保留卵巢手术的7例患者均未出现复发或死亡。2例患者怀孕并产下2名婴儿。单因素分析显示，FIGO分期、盆腔淋巴结（PLN）转移、淋巴管间隙浸润和间质浸润深度（<0.05）与PFS和OS显著相关。然而，多因素分析未发现显著的预后因素。
对于早期CCCC，保留卵巢治疗和保留生育功能手术是安全可行的。对于没有任何病理危险因素的早期CCCC，辅助治疗以外的监测可能是更好的选择。未来研究应探索更具针对性的治疗方法和免疫治疗。
