Crozier M, Morris M, Levenback C, Lucas K R, Atkinson E N, Wharton J T
Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Gynecol Oncol. 1995 Jul;58(1):74-8. doi: 10.1006/gyno.1995.1186.
The objective of this study was to describe and compare the outcome of patients with recurrent adenocarcinoma versus squamous cell carcinoma of the uterine cervix who have been treated with pelvic exenteration. All patients undergoing pelvic exenteration for cervical adenocarcinoma from 1955 to 1989 were identified and a retrospective review was conducted. For these 35 patients, we identified 70 controls who had exenteration for squamous cell carcinoma and who were matched for node status, year of procedure, and type of procedure. No significant difference was noted between the control group and the adenocarcinoma group for size of recurrent tumor, status of margins, presence of hydronephrosis prior to exenteration, and the time elapsed from initial diagnosis to exenteration. The two groups were compared for survival and recurrence pattern. Median patient age was 47 years (range 22-70). All patients had prior pelvic radiotherapy. Thirty patients had total pelvic exenteration and 5 had anterior exenteration. There were 3 postoperative deaths (8.6%). Median survival was 38 months for the adenocarcinoma patients and 25 months for the squamous patients (P > 0.99). The overall survival between the two sets of patients was very similar (log rank P = 0.86). There were 23 postexenteration recurrences among the adenocarcinomas (22 in which the site is known) and 32 postexenteration recurrences among the squamous patients (30 with known site). For the adenocarcinoma patients, 14 of 22 had a distant recurrence versus 14 of 30 for the squamous patients (P = 0.27). Patients with central recurrence of cervical adenocarcinoma can be successfully treated with pelvic exenteration and have survival rates similar to squamous carcinoma.
本研究的目的是描述并比较接受盆腔脏器清除术治疗的复发性子宫颈腺癌与鳞状细胞癌患者的治疗结果。确定了1955年至1989年间所有因宫颈腺癌接受盆腔脏器清除术的患者，并进行了回顾性研究。对于这35例患者，我们确定了70例因鳞状细胞癌接受脏器清除术的对照患者，这些对照患者在淋巴结状态、手术年份和手术类型方面进行了匹配。在复发性肿瘤大小、切缘状态、脏器清除术前肾盂积水情况以及从初始诊断到脏器清除术的时间间隔方面，对照组与腺癌组之间未发现显著差异。比较了两组患者的生存率和复发模式。患者中位年龄为47岁（范围22 - 70岁）。所有患者均曾接受盆腔放疗。30例患者接受了全盆腔脏器清除术，5例接受了前盆腔脏器清除术。术后有3例死亡（8.6%）。腺癌患者的中位生存期为38个月，鳞状细胞癌患者为25个月（P>0.99）。两组患者的总生存率非常相似（对数秩检验P = 0.86）。腺癌患者中有23例术后复发（22例复发部位已知），鳞状细胞癌患者中有32例术后复发（30例复发部位已知）。对于腺癌患者，22例中有14例发生远处复发，鳞状细胞癌患者30例中有14例发生远处复发（P = 0.27）。子宫颈腺癌中心复发的患者可通过盆腔脏器清除术成功治疗，生存率与鳞状细胞癌相似。
