118例ⅡB～ⅣA期宫颈腺癌单纯放疗与同步放化疗生存情况及其预后因素分析

目的:探讨ⅡB~ⅣA期宫颈腺癌患者采用单纯放疗与同步放化疗的生存情况,并分析影响其预后的相关因素,从而探讨ⅡB~ⅣA期宫颈腺癌较理想的治疗方法。方法:回顾性分析1986年1月至2010年12月于我院接受单纯放疗与同步放化疗治疗的ⅡB~ⅣA期宫颈腺癌患者118例的临床资料,对其生存情况及预后相关因素进行分析。结果:本组病例5年总体生存率为47.5%,行单纯放疗与同步放化疗的5年生存率分别为32.7%和59.1%,差异有统计学意义(P0.05)。按分期分层分析:单纯放疗组与同步放化疗组ⅡB期5年生存率分别为48.3%和63.3%,差异无统计学意义(P0.05)。ⅢB期5年生存率分别为22.2%和47.1%,差异有统计学意义(P0.05)。按组织学分级分层分析:单纯放疗组与同步放化疗组5年生存率G1分别为42.9%和61.9%,差异无统计学意义(P0.05);G2分别为33.3%和55.2%,G3分别为18.2%和50.0%,差异均有统计学意义(P0.05)。单因素分析与多因素分析均提示临床分期、组织学分级、肿瘤最大径线及治疗方法是影响ⅡB~ⅣA期宫颈腺癌预后的独立因素(P0.05)。结论:ⅡB~ⅣA期宫颈腺癌单纯放疗与同步放化疗相比,同步放化疗有一定优势,尤其是对ⅢB期及组织学分级G2、G3的患者,能够提高5年生存率。临床分期、组织学分级、肿瘤最大径线及治疗方法是影响ⅡB~ⅣA期宫颈腺癌预后的因素。     

同步放化疗与单纯放疗治疗中晚期宫颈癌疗效及毒性反应比较研究

目的 对比分析顺铂+氟尿嘧啶（PF方案）同步放化疗和单纯放疗治疗中晚期宫颈癌患者的疗效和毒性反应。方法 回顾性分析2007年3月至2008年10月辽宁省肿瘤医院收治的ⅡB～Ⅲ期宫颈癌患者共264例,分为同步放化疗组132例和单纯放疗组132例,对比分析两组患者的疗效和毒性反应。结果 同步放化疗组和单纯放疗组患者的（完全缓解+部分缓解）有效率分别为96.2%和91.7%,差异无统计学意义（P>0.05）。同步放化疗组与单纯放疗组5年生存率分别为68.9%和62.1%,差异有统计学意义（HR=2.794,P<0.01）。两组ⅡB期患者的5年生存率分别为84.8%和73.0%（P>0.05）。两组Ⅲ期患者的5年生存率分别为63.6%和48.3%（P<0.05）。同步放化疗组和单纯放疗组近期毒性反应以骨髓抑制为主,其中3级以上白细胞减少发生率分别为20.5%和4.5%（P<0.01）。3级以上放射性直肠炎发生率分别为0.7%和2.3%、3级以上放射性膀胱炎发生率分别为3.8%和1.5%（均P>0.05）。结论 同步放化疗能提高Ⅲ期宫颈癌患者的5年生存率。3级以上白细胞减少的发生率增加,3级以上放射性直肠反应、放射性膀胱反应的发生率不增加,毒性反应可以接受。     

ⅠA～ⅡB期子宫颈鳞癌预后影响因素的临床分析

目的探讨ⅠA~ⅡB期宫颈鳞癌患者预后的相关临床高危因素。方法对2004年11月—2013年7月在北京大学人民医院接受广泛/次广泛子宫切除术+盆腔淋巴结切除/取样术的296例ⅠA~ⅡB期宫颈鳞癌患者的临床病理资料进行回顾性分析。结果 296例宫颈鳞癌患者中,按国际妇产科联盟(FIGO)2009临床分期:ⅠA期33例,ⅠB期143例,ⅡA期61例,ⅡB期59例。患者3年生存率为96%,5年生存率为87%,总体生存率为87%。单因素分析显示,临床分期、新辅助化疗、脉管内癌栓、宫颈间质浸润深度、宫旁浸润、盆腔淋巴结转移、盆腔淋巴结阳性数目与宫颈鳞癌预后密切相关(P0.05);多因素分析显示,盆腔淋巴结阳性数目(P=0.003)及宫颈间质浸润深度(P=0.026)是影响ⅠA~ⅡB期宫颈鳞癌患者预后的独立危险因素。结论ⅠA~ⅡB期宫颈鳞癌患者若盆腔淋巴结阳性数目2和(或)宫颈间质浸润深度1/2,预后往往较差。     

宫颈小细胞神经内分泌癌19例临床分析 #br#

目的：探讨宫颈小细胞神经内分泌癌的临床病理特征、治疗及预后特点。方法：回顾性分析2012年6月-2017年9月郑州大学第一附属医院收治的19例宫颈小细胞神经内分泌癌患者的临床病例资料。结果：患者年龄30～63岁,平均（45.8±10.0）岁。肿瘤最大径2～10 cm,平均（4.29±2.43）cm。ⅠB1期7例,ⅠB2期5例,ⅡA1期2例,ⅡB期4例,ⅢB期1例。其中16例合并人乳头瘤病毒18（HPV18）感染,1例合并HPV16感染。17例行根治性手术+术后辅助化疗,其中8例接受新辅助化疗,9例术后接受放疗,余2例未手术者接受放化疗。1年、2年及5年无进展生存率分别为58.6%、50.2%、12.6%,1年、2年及5年生存率分别为72.8%、54.6%、27.3%。单因素分析发现临床分期（＞ⅡA）、合并淋巴结转移、肿瘤大小（＞4 cm）为患者预后的危险因素。结论：宫颈小细胞神经内分泌癌发病率低,恶性程度高,确诊依赖于病理,根治性手术是早期患者的主要治疗方案,辅助化疗具有重要意义。     

宫颈小细胞神经内分泌癌19例临床分析

目的:探讨宫颈小细胞神经内分泌癌的临床病理特征、治疗及预后特点。方法:回顾性分析2012年6月—2017年9月郑州大学第一附属医院收治的19例宫颈小细胞神经内分泌癌患者的临床病例资料。结果:患者年龄30～63岁,平均(45.8±10.0)岁。肿瘤最大径2～10 cm,平均(4.29±2.43)cm。ⅠB1期7例,ⅠB2期5例,ⅡA1期2例,ⅡB期4例,ⅢB期1例。其中16例合并人乳头瘤病毒18(HPV18)感染,1例合并HPV16感染。17例行根治性手术+术后辅助化疗,其中8例接受新辅助化疗,9例术后接受放疗,余2例未手术者接受放化疗。1年、2年及5年无进展生存率分别为58.6%、50.2%、12.6%,1年、2年及5年生存率分别为72.8%、54.6%、27.3%。单因素分析发现临床分期(ⅡA)、合并淋巴结转移、肿瘤大小(4 cm)为患者预后的危险因素。结论:宫颈小细胞神经内分泌癌发病率低,恶性程度高,确诊依赖于病理,根治性手术是早期患者的主要治疗方案,辅助化疗具有重要意义。     

ⅠB2和ⅡA2期宫颈癌术前放疗联合手术与根治性放化疗的疗效和生活质量对比北大核心CSCD

目的探讨术前放疗联合手术治疗ⅠB2、ⅡA2期宫颈癌的疗效和晚期不良反应。方法 96例病理确诊的初治ⅠB2、ⅡA2期宫颈癌患者,随机分为术前放疗组和同期放化疗组,术前放疗组患者采用盆腔适形调强放疗联合腔内后装放疗,放疗后行广泛性子宫切除＋盆腔淋巴结清扫术。同期放化疗组接受盆腔外照射联合后装放疗,同期顺铂化疗增敏。结果术术前放疗组及根治性放疗组患者的5年无进展生存率（PFS）分别为62.0%、45.8%（χ2=3.854,P=0.05）;5年总生存率分别为70.2%、60.4%（χ2=1.987,P=0.159）;远期生活质量FACT-Cx量表的五大模块得分相当,两组无明显差异。结论术前放疗联合手术延长了ⅠB2、ⅡA1期宫颈癌的无进展生存率,且长期生活质量无明显差异,是临床可行的治疗模式。     

ⅠB2和ⅡA2期宫颈癌术前放疗联合手术与根治性放化疗的疗效和生活质量对比

目的探讨术前放疗联合手术治疗ⅠB2、ⅡA2期宫颈癌的疗效和晚期不良反应。方法 96例病理确诊的初治ⅠB2、ⅡA2期宫颈癌患者,随机分为术前放疗组和同期放化疗组,术前放疗组患者采用盆腔适形调强放疗联合腔内后装放疗,放疗后行广泛性子宫切除+盆腔淋巴结清扫术。同期放化疗组接受盆腔外照射联合后装放疗,同期顺铂化疗增敏。结果术术前放疗组及根治性放疗组患者的5年无进展生存率(PFS)分别为62.0%、45.8%(χ2=3.854,P=0.05);5年总生存率分别为70.2%、60.4%(χ2=1.987,P=0.159);远期生活质量FACT-Cx量表的五大模块得分相当,两组无明显差异。结论术前放疗联合手术延长了ⅠB2、ⅡA1期宫颈癌的无进展生存率,且长期生活质量无明显差异,是临床可行的治疗模式。     

单纯放疗与以顺铂为主的同步放化疗治疗子宫颈癌的临床效果对比分析

目的对比分析单纯放疗及应用以顺铂为主的同步放化疗治疗宫颈癌初治患者的疗效和并发症。方法选择2000-2006年北京妇产医院收治的初治宫颈癌患者共197例,临床分期为Ⅰb-Ⅳa期,按治疗方法不同分为单纯放疗组（共100例,给予^60Co盆腔外照射及^192Ir腔内后装照射）和同步放化疗组（共97例,给予以顺铂为主的化疗,同步给予放疗,放疗方案与单纯放疗组相同）,对两组患者的疗效及并发症发生情况进行对比分析。结果单纯放疗组与同步放化疗组有效率分别为92％和89％,两组比较,差异无统计学意义（P=0．500）;其5年生存率分别为82％和79％,两组比较,差异无统计学意义（P=0．177）。单纯放疗组和同步放化疗组中Ⅲ期以上、病理分级G3、鳞癌患者的5年生存率分别为56％和84％,两组比较,差异有统计学意义（P〈0．01）;同步放化疗组和单纯组的近期并发症均以骨髓抑制为主,其中Ⅲ度以上骨髓抑制的发生率分别为14％和3％,两组比较,差异有统计学意义（P〈0．01）;其远期并发症的发生率分别为11％和8％,两组比较,差异无统计学意义（P=0．496）。结论应用以顺铂为主的同步放化疗治疗Ⅲ期以上、病理分级G3、鳞癌患者可明显提高其5年生存率。     

影响中晚期宫颈癌同步放化疗疗效的临床病理因素分析

目的 探讨影响中晚期宫颈癌同步放化疗疗效的临床病理因素.方法 回顾性分析2000-01-01-2006-12-30广西医科大学肿瘤医院妇瘤科收治的经病理确诊且资料完整的88例接受了首次同步放化疗的ⅡB～Ⅳ期宫颈癌患者的临床资料;同时与同期收治的70例行非同步放化疗的ⅡB～Ⅳ期宫颈癌患者进行对比分析.结果 (1)同步放化疗组的累积生存率:1、3、5年的生存率分别为89.77%、63.91%、50.03%,中位生存期56个月;非同步放化疗组的累积生存率:1、3、5年的生存率分别为90.00%、47.36%、29.09%,中位生存期(34个月),两组比较差异有统计学意义(P=0.005).(2)非同步放化疗患者的复发率(15.71%)高于同步放化疗组(4.55%),差异有统计学意义(P=0.017).(3)顺铂(DDP)增敏化疗的次数、DDP总剂量/总治疗时间比值、外照射放疗(EBRT)总剂量/总治疗时间(OTT)比值是影响中晚期宫颈癌同步放化疗疗效的因素.(4)多因素分析提示肿瘤的病理类型(P<0.1)、DDP总剂量/总治疗时间比值(P<0.05)、EBRT总剂量/OTT比值(P<0.1)是决定预后的独立因素.结论 同步放化疗能改善中晚期宫颈癌患者预后.而肿瘤的病理类型、DDP总剂量/总治疗时间比值和EBRT总剂量/OTT比值是影响其疗效的重要因素.     

宫颈残端癌53例临床特征及预后分析

目的:探讨宫颈残端癌的临床特征及影响预后的因素,为临床诊治提供参考。方法:收集53例宫颈残端癌患者的临床资料进行回顾性分析,用卡方检验、Kaplan-Meier法、Log-rank检验和COX回归模型进行统计学分析。结果:中位发病年龄为46岁,24例(45.28%)表现为阴道不规则流血。ⅠA1～ⅠB1、ⅡA1期18例中15例行根治性宫颈切除术+盆腔淋巴结切除术;ⅠB2、ⅡA2、ⅡB期13例中10例新辅助化疗后,行根治性宫颈切除术+盆腔淋巴结切除术;ⅢA～ⅣB期22例中14例行放疗同步化疗,其余行单纯化疗或放疗。术后有高危因素的患者中18例补充放疗和(或)化疗。中位生存时间为45.9个月,5年生存率为53.2%。多因素分析显示FIGO临床分期(P=0.042)、组织学分级(P=0.034)、脉管瘤栓(P=0.038)是影响预后的独立危险因素。肿瘤直径大小及组织学分级与脉管瘤栓发生有关。结论:宫颈残端癌临床表现主要为阴道不规则流血,治疗以手术和放疗为主,但预后较差。FIGO临床分期高(ⅡB～Ⅳ期)、组织学分级低分化、有脉管瘤栓是影响预后的因素。     

不同放化疗方案治疗中晚期宫颈癌的疗效比较

目的比较中晚期宫颈癌不同放化疗方案的疗效和毒性反应,以指导临床。方法2003年1月至2004年12月福州总医院放疗科收治的符合入组标准的ⅡB～ⅢB期宫颈癌患者111例,随机分为顺铂(DDP)+5-Fu组(DF组)、DDP组和DDP周疗组。比较各组患者的5年生存率和毒性反应。结果111例患者的中位随访时间为62个月,DF组、DDP组和DDP周疗组患者5年生存率分别为31.1%、38.4%和41.5%,差异无统计学意义(P=0.772)。DF组Ⅲ～Ⅳ度急性放射性肠炎高于其他两组(P=0.046),3组迟发性毒性反应比较,差异无统计学意义(P=0.953);DF组生存率与DDP组、DDP周疗组比较,差异亦无统计学意义(P=0.111和0.069);DDP组和DDP周疗组合并与DF组比较,5年生存率分别为31.1%和39.5%,差异有统计学意义(P=0.043)。结论每周顺铂同步放化疗方案治疗中晚期宫颈癌,有明显的放疗增敏作用,放射性肠损伤轻,远期疗效较好。     

Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer

BACKGROUND: Regarding complications of radiotherapy, the indications for adjuvant radiotherapy should be restricted. We conducted the present study to determine whether deep stromal invasion of the cervix could be excluded from the criteria used to identify patients for this treatment surgery. METHODS: This study included 115 patients with FIGO stage Ib to IIb cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. Patients had the following tumors: 61 nonkeratinizing squamous cell carcinoma, 21 keratinizing squamous cell carcinoma, 26 adenocarcinoma, and 7 adenosquamous cell carcinoma. Our study criteria for using adjuvant radiotherapy included positive lymph node involvement, a compromised surgical margin, or parametrial extension. Deep stromal invasion of the cervix was excluded from the criteria in this study. RESULTS: Seventy-two of the 115 patients (62.6%) underwent radical surgery only and all were alive. The remaining 43 patients received a complete course of external irradiation following radical surgery. The estimated 5-year survival rate is 100% for patients with stage Ib, 93.3% for stage IIa, and 52.7% for stage IIb. Fifty-five patients (47.8%) had deep stromal invasion. The prognosis for patients with deep stromal invasion was significantly worse than that for patients without deep stromal invasion (5-year survival rate, 69.8% vs. 98.0%). However, 21 patients (18.3%) with deep stromal invasion, but without positive lymph node involvement, compromised surgical margin, or parametrial extension, were alive without recurrence. Multivariate analysis showed that lymph node involvement and parametrial extension were independent prognostic factors, but that deep stromal invasion was not. CONCLUSION: Deep stromal invasion of the cervix can be excluded from the list of criteria for selecting patients with cervical cancer who would benefit from adjuvant radiotherapy following radical surgery.     

子宫颈小细胞神经内分泌癌的临床病理分析

目的 分析宫颈小细胞神经内分泌癌(SCNCC)的临床病理特征、诊断、治疗及预后.方法 回顾性分析2006年3月-2010年7月在广西医科大学附属肿瘤医院诊治的12例SCNCC患者的临床病理资料,包括临床特征(患者的年龄、临床分期、肿瘤类型及大小)、病理特征(肿瘤浸润、淋巴结转移、免疫组化检测结果 )、治疗及预后.结果 (1)临床特征:12例患者的平均年龄38.7岁(28～57岁);临床分期:按国际妇产科联盟(FIGO,2009年)标准,Ⅰ b1～Ⅱa期6例,Ⅱb～Ⅳ期6例;肿瘤类型及大小:9例为外生型菜花样肿物,其中7例直径≥4 cm,2例＜4 cm;2例为宫颈糜烂;1例宫颈光滑但颈管增粗.(2)病理特征:8例手术患者(Ⅰ b1～Ⅲb期)中,肿瘤浸润达间质深层(≥1/2宫颈间质)6例,达间质全层2例;盆腔淋巴结转移4例.免疫组化检测显示,嗜铬素A(CgA)、突触素、神经元特异性烯醇化酶(NSE)、细胞角蛋白(CK)、CD56的阳性率分别为8/12、9/10、4/4、4/4、4/4.(3)治疗及预后:8例手术患者中,7例行广泛性子宫切除+双侧(或单侧)附件切除+盆腔(或加腹主动脉旁)淋巴清扫术,1例行广泛性子宫切除+双侧卵巢移位+盆腔淋巴清扫术.其中,4例术前、8例术后接受了辅助治疗(化疗或加放疗).中位随访时间为3个月(1～22个月),8例手术患者中,4例发生转移,其无瘤生存时间分别为3～17个月,其中2例分别于术后8.5、11.3个月死亡;4例患者仍存活,在随访期间,未见明确肿瘤复发和转移表现.未手术的4例患者(Ⅲb～Ⅳ期)中,1例予同步放化疗者确诊后已存活10.1个月,仍在随访中;2例未治疗患者分别于确诊后0.6及1.3个月死亡;1例未治疗患者失访.结论 SCNCC恶性程度高,易发生远处转移,预后差,诊断应联合组织病理学检查及免疫组化法检测,采用以手术为主的综合治疗可改善部分患者的预后.

Abstract：

Objective To analyse the clinico-pathologic characteristics,diagnosis,therapy and prognostic of small cell neuroendocrine carcinoma of the cervix(SCNCC).Methods The clinic-pathological features of 12 patients with SCNCC treated in Tumor Hospital of Guangxi Medical University,admitted during March 2006 to July 2010,were analyzed retrospectively.Results Of 12 patients,the mean age was 38.7 years(rang 28-57 years),6 had stages Ⅰ b1-Ⅱa,6 had stagesⅡb-Ⅳ.Among 8 patients(Ⅰ b1-Ⅲb)underwent surgery,4 of them received neoadjuvant chemotherapy,8 of them received adjuvant chemotherapy and(or)radiotherapy.All had greater than one-half stromal invasion,4 patients had positive pelvic lymph nodes metastases.The positive ratio of the chromogranin(CgA),synaptophysin,neuronspecific enolase(NSE),cytokeratins(CK),CD56 tested by immunohistochemical staining were 8/12,9/10,4/4,4/4,4/4,respectively.Median follow-up period was 3 months(1-22 months).Among 8 patients underwent surgery,2 patients developed lung metastases,1 patient developed liver and lung metastases,1 patient developed liver metastases concurrently with bone metastases,disease-free survival (DFS)were 3 months(Ⅰ b2 with positive lymph nodes),4.6 months(Ⅱ a),7 months(Ⅰ b1),17 months (Ⅰ b2);2 patient died(8.5 and 11.3 months,respectively)after surgery;4 patients are alive and show no evidence of disease.Among 4 patients untreated,1 patients received concurrent chemoradiation and are alive for 10.1 months.Two patient untreated(Ⅲb,Ⅳ)died after 0.6 and 1.3 months final diagnosis,respectively.One patient Was lost follow-up.Conclusions SCNCC is a highly malignant tumor with rare morbility,propensity for distant spread and dismal prognosis.Final diagnosis of SCNCC depends on pathomorphology and immunohistochemical analysis.Combined therapeutic modalities may in favor of survival in some patients.     

子宫颈小细胞癌10例临床与预后分析

目的 :研究子宫颈小细胞癌 (SCCC)的临床病理、生物学行为特征及预后 ,探讨其治疗方法。方法 :回顾性分析 10例SCCC患者的临床病理资料及随访记录。结果 :SCCCⅠb期 2例、Ⅱa期 4例、Ⅲb期 4例 ,SCCC早期即可发生盆腔淋巴结转移 ,并很容易转移至肺、肝等器官 ;对 10例患者采用手术 +放疗 +化疗或放疗 +化疗的综合治疗 ,5例分别已存活 37、2 7、16、10、9个月 ,另 5例分别存活 10、10、11、13、14个月后死亡。结论 :SCCC与肺小细胞癌的组织病理学和生物学行为特征相似 ,早期容易发生盆腔淋巴结转移和远处转移 ,对化学治疗比较敏感 ,早期患者应行子宫广泛性切除术 +盆腔淋巴结清扫术 ,术后给予辅助性放疗和化疗 ;晚期患者应采用放疗 +化疗。化疗目的在于预防或治疗远处转移性病变     

Small cell carcinoma of the cervix: a case report

Small cell carcinoma of the uterine cervix accounts for 1–3% of all cervix cancers. It is an aggressive disease with a poor prognosis. To date, no effective treatment protocol has been determined. Surgery, radiotherapy, and chemotherapy have been used either alone or in combination. Recent data suggests that survival in patients with early staged small cell carcinoma of the cervix is better with surgery combined with chemo-radiotherapy. Here, we presented two patients with stage IB1 small cell carcinoma of the uterine cervix. For both patients, definitive surgery was performed with pelvic and para-aortic lymphadenectomy. Subsequently, they were treated with pelvic external radiotherapy and high-dose-rate intracavitary brachytherapy with concurrent cisplatin based chemotherapy. They were alive with no evidence of disease at 91 and 65 months, respectively.     

52例原发性阴道癌临床分析

Objective?To investigate the clinical features and prognostic factors of primary vaginal cancer. Methods?A total of 52 patients with complete pathological diagnosis and clinical follow-up data were selected from the first Affiliated Hospital of Zhengzhou University from January 2013 to January 2020. The general characteristics, different treatment methods and overall prognosis of the patients were analyzed. Results?the 1-year, 3-year and 5-year survival rates of 52 patients with primary vaginal cancer were 80.7%, 61.1%, and 48.1%, respectively. Among them, 28 patients (53.8%) had squamous cell carcinoma, and the median survival time was 92 months. There were 12 cases of malignant melanoma (23.0%), and the median survival time was 12 months The 5-year survival rates of early stage (stageⅠ+stageⅡ) and late stage (stageⅢ+stageⅣ) were 61.0% and 0.0%, respectively. Univariate analysis showed that FIGO stage, pathological type, tumor size, treatment mode, tumor growth stage and vaginal invasion length were related to the prognosis of patients (P<0.05). COX multivariate regression analysis showed that 2009 FIGO stage (P=0.002) and pathological type (P=0.000) were independent factors affecting the prognosis of patients with primary vaginal cancer.  The prognosis of different pathological types, such as squamous cell carcinoma and malignant melanoma, was significantly different (χ2=17.704, P=0.000). There was statistically significant difference between combined radiotherapy and chemotherapy with radiotherapy or chemotherapy alone (χ2= 4.017, P=0.045). Conclusion?The prognosis of primary vaginal cancer is related to pathological type and clinical stage. The earlier the clinical stage, the better the prognosis. The survival cycle of squamous cell carcinoma is much higher than that of malignant melanoma. The treatment is mainly radiotherapy, and the combined treatment of radiotherapy and chemotherapy is better than radiotherapy or chemotherapy alon.     

子宫颈腺鳞癌21例临床分析

目的 探讨宫颈腺鳞癌的临床特征、治疗模式及其对预后的影响.方法 回顾性分析武汉大学中南医院2001年1月至2005年12月收治的21例宫颈腺鳞癌患者的临床资料.根据治疗方式的不同分为单纯手术治疗(6例)和综合治疗(15例),分析不同治疗模式对预后的影响.结果 患者的中位年龄45岁,以未绝经患者(15例,占71%)为主;平均病程5.3个月(0.5～24.0个月),其中16例病程＜6个月;临床症状主要为阴道流血(17例,占81%).21例患者中,盆腔淋巴结转移7例(33%),卵巢转移3例(14%).21例患者的中位生存时间为54个月.其中,单纯手术治疗和综合治疗患者的中位生存时间分别为20、54个月,两者比较,差异无统计学意义(P＞0.05).12例Ⅰ b-Ⅱa期患者中,单纯手术治疗6例,综合治疗6例,其中位生存时间分别为20、66个月,两者比较,差异有统计学意义(P＜0.05).结论 宫颈腺鳞癌具有病程短、进展快、预后差的特点,应采取综合治疗措施,术中保留卵巢需谨慎.     

子宫颈鳞状细胞癌复发患者血清鳞状细胞癌抗原监测的意义

目的探讨血清鳞状细胞癌抗原（SCCAg）在监测宫颈鳞癌患者复发中的意义。方法对1999-2005年收治的72例宫颈鳞癌复发患者血清SCCAg水平与诊断、预后的关系进行单因素和多因素分析。结果72例复发患者中,术后复发30例、放化疗后复发42例,其中血清SCCAg水平升高者61例（占85％）。此61例患者中,20例在随诊中首先出现血清SCCAg水平升高而临床及影像学检查未发现肿瘤,血清SCCAg水平提前升高的中位时间为3个月,平均4．6个月（1～13个月）。72例复发患者中,45例患者无任何临床症状,仅因血清SCCAg水平升高或常规随诊发现复发;27例患者有症状,其中单侧下肢水肿或疼痛15例,阴道不规则流血7例,出现远处转移相关症状5例。细胞或组织病理学检查诊断复发者33例;临床及影像学检查结合血清SCCAg水平诊断复发者39例,其中29例仅依靠血清SCCAg水平升高及影像学检查即诊断复发。72例复发患者的中位生存时间为11个月,平均生存时间为23个月（2～62个月）,总的3年生存率为25％,5年生存率为19％。单因素分析发现,初治前患者血清SCCAg水平、病理分级、复发部位、复发后治疗方式以及复发时、复发后治疗中、治疗后血清SCCAg水平对患者的3年生存率有明显影响（P〈0．01）;但20例血清SCCAg水平提前出现升高的患者与52例血清SCCAg水平未提前升高的患者相比,3年生存率分别为22％、27％,差异无统计学意义（P=0．5761）。多因素分析发现,复发患者仅病理分级、复发后的治疗方式是独立的预后影响因素（P〈0．05）;而复发部位及各种血清SCCAg状态不是独立的预后影响因素（P〉0．05）。结论血清SCCAg水平监测在宫颈鳞癌复发患者中的诊断及其对预后的判断中有一定的价值。     

Concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy for women with locally advanced carcinoma of the uterine cervix--final results of a prospective phase II-study

OBJECTIVES: To evaluate the efficacy and toxicity of ifosfamide and cisplatin administered concomitantly with low-dose rate brachyradiotherapy followed by consolidation chemotherapy in the treatment of locally advanced squamous cell carcinoma (LASCC) or adeno/adenosquamous carcinoma of the uterine cervix. METHODS: Sixty-two patients with primary uterine cervical cancer were enrolled between August 1999 and November 2004. The patients had to have FIGO-stage IB2 bulky to IVA disease, biopsy-proven squamous cell or adeno/adenosquamous carcinoma of the uterine cervix. The patients were to receive external radiotherapy (50 Gy in 25 fractions); ifosfamide 2 g/m2 plus cisplatin 75 mg/m2 was applied concomitantly during two low-dose rate brachyradiotherapy applications; the planned dose to point A was 85 Gy in total. After the completion of radiotherapy, i.e. external and concomitant chemobrachyradiotherapy, four cycles of consolidation chemotherapy with the same drug combination were to be administered. RESULTS: The clinical complete response rate according to WHO-classification (assessed after the completion of the whole treatment procedures by gynecologic and radiologic evaluation and cervical biopsy) was 100%. After a median follow-up of 49 months (range 11-74 months), the recurrence-free and overall survival rates were 88.7%, respectively. The most frequent early toxicities were grade 3 and 4 leukopenias occurring in 25% and 11% of the cycles, respectively. Major delayed local complications occurred in 10 patients (16.1%). CONCLUSION: These results indicate that concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy with the same drug combination is a highly efficacious and very promising treatment protocol for patients with locally advanced LASCC or adeno/adenosquamous carcinoma of the uterine cervix.