Chen R J, Chang D Y, Yen M L, Lee E F, Huang S C, Chow S N, Hsieh C Y
Department of Obstetrics and Gynecology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
Gynecol Oncol. 1998 May;69(2):157-64. doi: 10.1006/gyno.1998.4971.
To determine which clinicopathological factors influence the prognosis of cervical adenocarcinoma.
Three hundred and two cases of primary adenocarcinoma of the uterine cervix, treated between 1977 and 1994, were studied retrospectively. Clinical data and pathological findings with respect to primary therapy were reviewed and evaluated.
The 5-year survival rates for stages I, II, and III/IV were 75.9, 62.9, and 25.1%, respectively. International Federation of Gynecology and Obstetrics stage (P < 0. 0001), cell type (P = 0.0176), tumor grade (P = 0.023), lymph node status (P = 0.018), and bulky tumor (P = 0.007) were found to be independent factors using the stepwise Cox proportional hazards model. Old age (P = 0.0581), presence of hypertension (P = 0.46), diabetes mellitus (P = 0.18), obesity (P = 0.15), and oral contraceptive use (P = 0.42) were not found to adversely influence survival rates for cervical adenocarcinoma after adjusting for other covariates. Adenosquamous adenocarcinoma had a better prognosis than endocervical columnar cell adenocarcinoma in stages I and II (P = 0. 0235). Also, in cervical adenocarcinoma's early stages, multivariate modeling revealed that chances of survival were significantly better for patients treated by radical surgery than for patients treated by radiation therapy (P < 0.001).
Survival rates for cervical adenocarcinoma were significantly influenced by stage, histologic subtype, tumor grade, the presence of a positive lymph node, and tumor size. Although a randomized prospective study is needed, our data imply that radical surgery may be considered a better primary modality of treatment than radiation therapy for the early stages of cervical adenocarcinoma. Further, the presence of hypertension, diabetes mellitus, or obesity may not adversely influence survival rates.
确定哪些临床病理因素会影响宫颈腺癌的预后。
回顾性研究了1977年至1994年间治疗的302例原发性子宫颈腺癌病例。对有关初始治疗的临床资料和病理结果进行了回顾和评估。
I期、II期和III/IV期的5年生存率分别为75.9%、62.9%和25.1%。采用逐步Cox比例风险模型发现，国际妇产科联盟分期（P<0.0001）、细胞类型（P = 0.0176）、肿瘤分级（P = 0.023）、淋巴结状态（P = 0.018）和肿瘤体积大（P = 0.007）是独立因素。在调整其他协变量后，未发现高龄（P = 0.0581）、高血压（P = 0.46）、糖尿病（P = 0.18）、肥胖（P = 0.15）和口服避孕药使用情况（P = 0.42）对宫颈腺癌生存率有不利影响。在I期和II期，腺鳞癌的预后优于宫颈管柱状细胞腺癌（P = 0.0235）。此外，在宫颈腺癌早期，多变量模型显示，接受根治性手术治疗的患者的生存机会明显优于接受放射治疗的患者（P<0.001）。
宫颈腺癌的生存率受分期、组织学亚型、肿瘤分级、淋巴结阳性情况和肿瘤大小的显著影响。尽管需要进行随机前瞻性研究，但我们的数据表明，对于宫颈腺癌早期，根治性手术可能被认为是比放射治疗更好的初始治疗方式。此外，高血压、糖尿病或肥胖的存在可能不会对生存率产生不利影响。
