5766例宫颈癌临床特征分析

目的:探讨近年我院宫颈癌的发病情况及临床特征,为宫颈癌有效预防和临床诊治提供科学依据。方法:选取新疆医科大学附属肿瘤医院2003年1月至2011年12月收治的宫颈癌患者5766例作为研究对象,对其发病情况及临床特征进行回顾性分析。结果:1各年份宫颈癌新发病例呈逐年增高趋势,各年间比较差异有统计学意义(P0.05)。2发病年龄36~60岁4294例,占74.5%,平均年龄49.65±10.98岁;9年间发病高峰年龄呈现年轻化的趋势。3发病人群维吾尔族共3278例,占56.9%,但汉族发病人群呈逐年增高趋势;4发病地区南疆地区共3307例,占57.4%,南、北疆患病人群无明显变化趋势;城市患者所占比例呈逐年增高趋势;5农民和家庭妇女共4171例,占72.3%,但干部及其他职业有增加趋势;小学以下文化程度患者共3423例,占59.4%,但大专以上文化程度患者比例呈增加趋势;6Ⅰ期、Ⅱ期患者比例增高,Ⅲ期、Ⅳ期患者呈下降趋势;鳞癌有逐渐降低、腺癌及腺鳞癌有逐渐增加趋势。结论:近年来我院宫颈癌发病和早期比例逐年增高,且具有年轻化趋势,汉族比例增多、城市人口比例增多,干部及其他职业宫颈癌患者所占比例有逐年增加趋势,大专以上文化程度宫颈癌患者比例有升高趋势,临床分期早、腺癌和腺鳞癌比例增多的趋势。     

宫颈癌治疗方法对生存质量的影响

宫颈癌是最常见的妇科肿瘤 ,全世界每年宫颈癌的发病人数达 371× 10 3 例 ,而病死可达 190× 10 3 例。近年来 ,随着人们对宫颈癌诊断治疗的逐渐完善 ,使其又具有以下新的特征 :①子宫颈癌发病年龄逐渐趋向于年轻化 ;②由于广泛开展宫颈癌预防普查 ,子宫颈癌的早期诊断率大大提高 ;③由于多种逐渐完善治疗手段的联合应用 ,使子宫颈癌生存率相对提高。基于以上新的特点 ,对于宫颈癌的治疗也随之建立了新的观念。既要使疾病得到充分的治疗 ,提高其生存率 ,还要保证年轻早期患者术后或放疗后的生活质量。因此 ,生存质量与宫颈癌治疗方法的选择…     

1134例宫颈组织病理检查结果分析

目的:探讨宫颈癌及CIN的发病趋势。方法:对2000~2001年及2004~2005年我院1134例宫颈组织病理学检查、HPV检测结果及患者年龄进行比较分析。结果:与2000~2001年比较,2004~2005年宫颈癌的发生率下降;CINⅡ~Ⅲ的发生率,尤其是≤35岁的CINⅡ~Ⅲ的发生率显著升高,差异有显著性或非常显著性(P<0.05,P<0.01);宫颈癌、CINⅡ~Ⅲ的平均发病年龄均下降(P<0.05);HPV感染发生率升高(P<0.01);宫颈癌、CIN患者中HPV感染平均年龄下降(P<0.05),≤35岁的宫颈癌、CIN患者HPV感染发生率高于>35岁者,差异有显著性(P<0.05)。结论:宫颈癌、CINⅡ~Ⅲ的年轻化趋势明显,且与HPV感染有关。     

AQP1和AQP3在子宫颈鳞状细胞癌中表达的研究

目的:探讨AQP1和AQP3在子宫颈癌中的表达及意义。方法:通过荧光定量PCR和免疫荧光检测AQP1和AQP3在人子宫颈癌SiHa细胞系中的表达,通过免疫组化检测AQP1和AQP3在35例维吾尔族子宫颈癌、15例CINⅢ和15例慢性宫颈炎中的表达。结果:(1)SiHa细胞中AQP1和AQP3在mRNA和蛋白水平均表达;(2)AQP1表达于宫颈病变组织间质血管内皮细胞的胞质,采用微血管密度(MVD)表示AQP1表达强度。慢性宫颈炎、CINⅢ和子宫颈癌组的MVD分别是43.6±17.8、56.2±11.6、70.8±21.1,宫颈癌组MVD显著高于CINⅢ组及慢性宫颈炎组(P均<0.05),CINⅢ和慢性宫颈炎组间差异无统计学意义;AQP3在慢性宫颈炎、CINⅢ和子宫颈癌组的阳性率分别是13.33%、26.67%、48.57%,子宫颈癌组与慢性宫颈炎组间差异有统计学意义(P=0.018),子宫颈癌组与CINⅢ、CINⅢ与慢性宫颈炎组间差异均无统计学意义(P均>0.05)。结论:AQP1和AQP3的表达可能与子宫颈癌的发生、发展有关。     

巨块型宫颈癌术前高剂量率腔内放疗近期疗效分析

目的探讨巨块型宫颈癌根治术前高剂量率腔内近距离放疗(ICBT)的治疗效果。方法对200001-200412中山大学附属肿瘤医院和附属第二医院收治的51例ⅠB2～ⅡB期巨块型宫颈癌根治术前采用ICBT,对患者的局部肿瘤缓解情况、毒副反应、手术情况及高危病理因素进行回顾性分析;与同期直接接受根治术的同期别56例巨块型宫颈癌比较。结果施行ICBT后,宫颈肿瘤临床完全缓解5.9%(3/51),部分缓解51.0%(26/51),无变化43.1%(22/51),恶化0。并发症发生率较低,主要是骨髓抑制、腹泻、放射性直肠炎和膀胱炎。全部患者均按宫颈癌根治术规范完成。ICBT组较直接手术组手术时间缩短(3.58±1.08)h对(4.46±0.93)h,术中出血量减少(395.1±219.8)mL对(999.1±637.4)mL,术后拔尿管时间缩短(11.47±6.48)d对(15.18±8.41)d,尿潴留的发生率减少(37.25%对48.2%)。除尿潴留外,两组比较差异均有显著性(P<0.05)。高危病理差异无显著性(P>0.05)。结论宫颈癌根治术前适当剂量腔内放疗是较早期巨块型宫颈癌较理想的治疗方案。     

宫颈癌患者末梢血腺苷脱氨酶活性表达57例初步分析

目的:探讨宫颈癌患者末梢血腺苷脱氨酶(ADA)活性水平。方法:采用干燥全血ADA活性测定法对57例宫颈癌患者及117例正常对照者末梢血ADA活性进行了测定。结果:宫颈癌患者ADA活性值为198.46±22.72 U/L明显低于正常对照组323.84±32.64 U/L,二者有显著差异性(P<0.01)。Ⅰa期宫颈癌组ADA活性值为176.32±18.20 U/L,明显低于宫颈原位癌组220.58±20.12 U/L;二者差异有显著意义(P<0.01)。结论:末梢血ADA活性表达与宫颈癌明显相关并随病程变化而有明显差异。     

介入化疗与放射治疗相结合治疗中晚期宫颈癌

近年 ,我们将介入化疗和放射治疗相结合治疗中晚期宫颈癌 30例 ,疗效较好 ,现报告如下。1　资料与方法1.1　临床资料　随机将 1996年 4月至 2 0 0 2年 4月确诊为Ⅱb～Ⅲ期宫颈癌患者 76例分为介入性新辅助化疗组 (A组 )和单纯放疗组 (B组 )。A组 30例中Ⅱb期 18例 ,Ⅲ期 12例。B组 4 6例中Ⅱb期 14例 ,Ⅲ期 32例。两组基本情况见表 1(P >0 .0 5 )。患者均为初治者 ,重要脏器功能正常 ,白细胞和血小板计数在正常范围。表 1　 2组基本情况比较组别n 年龄 (岁 )范围平均FIGO分期 (n)ⅡbⅢ病理分期 (n)鳞癌腺癌A组 3 0 2 3～ 65 44 1812 2 7…     

兰州大学第一医院近11年宫颈癌临床特点及发病趋势的研究

目的:探讨2007—2017年兰州大学第一医院(我院)确诊的宫颈癌患者的空间分布、发病趋势与临床特征。方法:收集2007—2017年我院确诊的1 023例宫颈癌患者的临床资料,采用趋势分析和卡方检验探讨其分布状况、年龄变化、临床特征、病理特点与发病趋势等。结果:①我院近11年收治的宫颈癌患者主要分布在甘肃省东南部,其中天水市最多(173例),其次为兰州市(168例),而我省西北部的患者较少,特别是敦煌市(9例);②我院医治的宫颈癌患者总数的年际变化呈增加趋势,变化率为6.98例/年,其中兰州市增加最多,为1.33例/年,而天水市增加最少;③患病年龄集中在40～49岁和50～59岁并存在大龄化趋势,即50～59岁的患者增多,而40～49岁的患者减少,其他年龄段患者所占比例较小,无明显变化特征;平均年龄介于50～59岁的患者主要分布在甘肃省东南部,包括嘉峪关市、金昌市、庆阳市等,而介于40～49岁的主要在甘南藏族自治州和酒泉市;④Ⅰa期、Ⅰb期、Ⅱa期和Ⅳ期的高发年龄段均为40～49岁,而Ⅱb期和Ⅲ期的高发年龄段为50～59岁;鳞癌为主要病理类型(占94.53%),其次为腺癌,腺鳞癌则较少见;⑤2007—2011年与2012—2017年宫颈癌患者临床分期、病理类型以及发病年龄比较,差异均无统计学意义(P0.05)。结论:我院确诊的宫颈癌患者主要分布在甘肃省东南部,年际变化呈增加趋势,患者年龄主要集中在50～59岁,呈大龄化趋势;Ⅰ期和Ⅱa期宫颈癌患者的发病年龄主要集中在40～49岁,Ⅱb期和Ⅲ期患者以50～59岁为主,这些年龄段患者均以鳞癌为主要病理类型。     

盆底康复在宫颈癌术后的应用

<正>1宫颈癌患者术后的盆底功能状况宫颈癌发病率占女性恶性肿瘤的第2位。我国每年新发病例约占世界宫颈癌新发病例的28.8%,且83.9%的患者接受手术治疗。近年来,随着宫颈癌筛查手段的普及与提高,患者呈现年轻化趋势且早期宫颈癌比例升高。临床分期为ⅡB期及以下宫颈癌患者行广泛性(PiverⅢ型)子宫切除+盆腔淋巴结切除术后     

水通道蛋白1、8在不同宫颈上皮病变组织中的表达及其意义

目的探讨水通道蛋白1(AQP1)和水通道蛋白8(AQP8)在维吾尔族妇女宫颈癌发生、浸袭过程中的表达及意义。方法选择2008年11月至2010年8月新疆医科大学附属肿瘤医院维吾尔族宫颈炎患者42例、宫颈上皮内瘤变(CIN)Ⅲ36例,宫颈癌98例。采用实时荧光定量RT-PCR方法和Western blot对其中10例宫颈炎和27例宫颈癌进行AQP1和AQP8 mRNA和蛋白检测;采用免疫组化对全部宫颈癌患者98例、CINⅢ36例及宫颈炎42例AQP1微血管密度和AQP8阳性率进行分析。结果 AQP1和AQP8在宫颈炎、宫颈癌早期(Ⅰb或Ⅱa期)及晚期(Ⅲ期)均有表达。宫颈炎组和宫颈癌早期、晚期组AQP1和AQP8 mRNA表达差异无统计学意义(P>0.05),而蛋白表达差异有统计学意义(P<0.01)。AQP1微血管密度和AQP8阳性表达率在宫颈炎、CINⅢ和宫颈癌组织中比较差异有统计学意义(P<0.01)。结论 AQP1和AQP8在宫颈癌发生、侵袭过程中可能发挥重要的生理作用。     

Screening history preceding a diagnosis of cervical cancer in women age 65 and older

Objective

To characterize the antecedent screening of women 65 years of age and older diagnosed with cervical cancer.

Methods

Screening histories of women 65 years of age and older who were diagnosed with cervical cancer between 2003 and 2008 were examined utilizing the organization's databases and the regional Cancer Registry. Stopping screening was recommended at age 65 for members who had either 3 consecutive negative Paps or a single negative Pap plus HPV test (“cotest”).

Results

From 2003 through 2008 there were 56 Kaiser Permanente Northern California members 65 years of age and older diagnosed with cervical cancer. During the same time period there were 1,323,100 woman-years of membership in women age 65 and older. The risk of invasive cancer among women age 65 and older was 4.2/100,000/year in 2003-2008. 33 of 56 (59%) had one or more Pap smears prior to diagnosis. Of the 33, 14 women (25%) had 3 consecutive negative Pap smears prior to diagnosis. Three of 46,401 women with 1 or more negative cotests at age 65 and older were subsequently diagnosed with invasive cancer during 132,639 women-years of follow-up (2.3/100,000/year).

Conclusions

Most cervical cancers diagnosed at age 65 and older occur in women who have not met our criteria for stopping screening. A few cancers will continue to occur at age 65 and older despite multiple negative tests, as is true in other age groups. We currently have no evidence that these cancers would be prevented with continued screening at ages 65 and older.     

Cervical cancer in women aged less than 25: East Kent experience.

The National Health Service Cervical Screening Programme (NHSCSP) guidelines raised the initiation of screening age from 20 to 25 years of age in 2004, on the basis that only 1.3% of cervical cancers occur in this age group. Between 2003 and 2005, cervical cancer was diagnosed in six women under 25 years in East Kent, 6.25% of 96 cervical cancers cases. All except one patient in our series presented with a cervical smear abnormality. High-grade cervical smear abnormalities were identified and treated in 187 women under 25 years during this period. Adoption of the guidelines may increase the incidence of invasive disease in young women, the stage at diagnosis and radicality of treatment required.     

Characteristics of 44 cervical cancers diagnosed following Pap-negative, high risk HPV-positive screening in routine clinical practice

Objective

To characterize the cervical cancers diagnosed following a Pap-negative, high risk human papillomavirus (HPV)-positive (Pap−/HPV+) screen in routine clinical practice.

Methods

Using data from Kaiser Permanente Northern California, we investigated the cases of cervical cancer diagnosed between January, 2003 and January, 2009 following Pap−/HPV+ screen. Two cervical specimens were routinely collected for cervical cancer screening, one for conventional cytology and the other for high risk HPV testing using Hybrid Capture 2 (Qiagen).

Results

Forty-four women (median age at diagnosis = 44 years) were diagnosed with primary invasive cervical cancer with a recent history of one or more Pap−/HPV+ screens. Twenty-six women had one Pap−/HPV+ screen preceding the diagnosis of cancer, 15 had two, and three had three. There were 16 squamous cancers, one small cell cancer, 24 adenocarcinomas, 2 adenosquamous carcinomas, and one case with separate invasive squamous and adenocarcinoma. FIGO Stage was IA in 11 women, IB in 31 women and IIA in 2 women. Treatment included a pelvic node dissection in 30, 2 (6.7%) of whom had positive nodes.

Conclusions

HPV testing contributes to early cervical cancer diagnosis detection in women with negative Pap tests. Most women in this cohort have early stage, node negative, treatable and potentially curable disease. Adenocarcinoma predominated as might be expected because cytology misses these cancers and their precursors. The majority of cancers were diagnosed following a single Pap−/HPV+ screen, suggesting that effective triage to colposcopy of women with a Pap−/HPV+ screen would be preferable to retesting in one year as currently recommended.     

Young age as a prognostic factor in cervical cancer: Results of a population-based study

Objective: Our goal was to use population-based data to determine the difference in 5-year survival in women diagnosed with cervical cancer between those aged 18-34 years and those aged 40-60 years. Study Design: The SEER (Surveillance, Epidemiology, and End Results) public-use database, 1973-1994, was used for this investigation. Only subjects with cervical carcinoma diagnosed between 1988 and 1990 were included. Subjects were stratified on age at diagnosis (<35 years or 40-60 years), clinical stage, histologic type, race-ethnicity, and grade. Results: Two thousand cases of invasive cervical cancer were identified. The younger subgroup of patients was diagnosed with earlier-stage disease more frequently than the older group (P = .0001). When adjustments were made for non–cervical cancer causes of death, there was no difference in 5-year survival between the 2 cohorts. African American women had a poorer 5-year survival (P = .02) Conclusion: There was no overall difference in survival between the 2 cohorts when appropriate adjustments were made for cause of death and for stage, histologic type, and grade of disease. (Am J Obstet Gynecol 1999;180:1464-7.)     

Younger age distribution of cervical cancer incidence among survivors of pediatric and young adult cancers

Background

Pediatric and young adult (PAYA) cancer survivors may have an earlier onset of chronic diseases compared with the general population. We compared the age at cervical cancer diagnosis between PAYA cancer survivors and females in the general US population.

Methods

We used longitudinal data from 9 population-based registries of the Surveillance, Epidemiology, and End Results program collected between 1973 and 2010. PAYA cancer survivors were females diagnosed with any cancer before age 30 years, survived at least 5 years post-diagnosis, and were subsequently diagnosed with invasive cervical cancer (n = 46). The general US population comprised females who were diagnosed with invasive cervical cancer as the primary malignancy (n = 26,956). We estimated the difference in median age at diagnosis (ß₅₀) and bootstrap 95% confidence limits (CL) of invasive cervical cancer after adjustment for year of diagnosis and race.

Results

The median age at diagnosis of invasive cervical cancer was 33 years for female PAYA cancer survivors and 40 years for females in the general US population (ß₅₀ = − 7.0, 95% CL: − 11, − 3.2). Similar differences were observed across subgroups of stage and histologic subtype of invasive cervical cancer.

Conclusion

Our results suggest that PAYA cancer survivors are diagnosed with invasive cervical cancer at a substantially younger age compared with females without a prior cancer diagnosis in the general US population. This issue warrants further study, and could have implications for determining age at initiation or frequency of cervical cancer screening if younger age at diagnosis is attributable to an underlying biological phenomenon.     

Intent-to-treat analysis of stage Ib and IIa cervical cancer in the United States: radiotherapy or surgery 1988-1995

OBJECTIVE: To estimate the patterns of care and outcome of women with early cervical cancer in the United States based on surgical or radiation intent-to-treat principles. METHODS: The Surveillance, Epidemiology, and End Results 1995 public-use file was the data source. Subjects between the ages of 15 and 80 years at diagnosis who were treated for stage Ib or IIa cervical cancer were identified. The 1039 women who comprised the study group were stratified according to age at diagnosis (40 years or less, older than 40 years), primary treatment intent (surgery, radiotherapy), tumor size (4 cm or less, over 4 cm), registry site, and ethnicity. Survival analyses included 784 women who had at least 2 years of follow-up. RESULTS: There were 276 cancers (26.5%) over 4 cm, and 586 (56%) women were older than 40 years at diagnosis. There were 741 (71%) subjects in the surgical intent-to-treat group, and the remainder (298) were in the radiation intent-to-treat group. Kaplan-Meier analysis indicated a 5-year survival advantage for women with tumors 4 cm or less who were in the surgical intent-to-treat group compared with the radiation intent-to-treat group (86% and 71%, P <.001). Treatment group was not prognostic for cervical cancers over 4 cm (surgical intent-to-treat compared with radiation intent-to-treat; 72% and 68% survival, respectively). Multivariable analysis confirmed a survival advantage for women with surgical intent-to-treat and tumors of 4 cm or less. CONCLUSION: In the United States there is a survival advantage for surgical intent-to-treat compared with radiation intent-to-treat for women with tumors 4 cm or less, independent of ethnicity, adjuvant therapy, or age.     

Screening practices and invasive cervical cancer risk in different age strata

Relative and population attributable risks for invasive cervical cancer in different age strata relative to screening practices have been estimated using data from a case-control study conducted since 1981 in the greater Milan area, northern Italy. A total of 548 women under 75 years of age with a histologically confirmed diagnosis of invasive cervical cancer were compared with 515 controls admitted to hospital for a spectrum of nongynecological, hormonal or neoplastic, acute conditions. The percentage of never-screened women increased with age: no Pap smear was reported in 34% of controls aged 44 years or younger and 63% of older women (greater than or equal to 65 years). A similar trend emerged in recency of Pap smear, with 14% of older controls and 52% of the younger group reporting a cervical smear within 3 years before the interview. The number of Pap smears was strongly and inversely related to cervical cancer risk at all ages. Compared with no Pap smear, three or more cervical smears decreased the risk of invasive cervical cancer by about 90%. Compared with women screened the last time 6 years before the interview or never, relative risks were about 60% lower in women reporting their last Pap within 2 years in all age groups. A slightly larger proportion of older cases were attributable to the absence or delay in the screening: population attributable risk estimates were 78% in women up to 55 years of age, and 86% in those 65 years or older. Thus, deficiencies in screening were greater at ages at which the incidence of disease was higher.     

Second primary cancers after cervical intraepithelial neoplasia III and invasive cervical cancer in Southeast England

OBJECTIVE: Multiple primary cancers may arise in an individual because they share a common environmental risk factor (such as smoking); genetic predisposition or immunodeficiency may predispose to both cancers, or treatment for one cancer may cause a second cancer. The objective of this analysis was to identify which, if any, cancers occur more often than would be expected in a cohort of women diagnosed with cervical intraepithelial neoplasia III (CIN III) and in women with invasive cervical cancer. METHODS: The Thames Cancer Registry was used to identify two cohorts of women diagnosed with either CIN III or invasive cervical cancer. The number of subsequent cancers at other sites was observed and compared to the expected number, based on relevant age-, sex-, and period-specific incidence rates. Standardised incidence rates (SIRs) were calculated assuming a Poisson distribution. RESULTS: The following cancer sites were significantly increased after a diagnosis of either CIN III or cervical cancer: anus (SIR 5.9 and 6.3, respectively), lung (SIR 1.8 and 2.5), vulva (SIR 4.4 and 1.9), vagina (SIR 18.5 and 8.0), and kidney (SIR 1.6 and 1.9). In addition, the incidence of cancers of the rectum, bladder, and connective tissue was significantly increased after invasive cervical cancer. Cervical cancers were seen significantly more often than expected after cancers of the anus and vagina. CONCLUSION: These results support the hypothesis that cancers of the cervix, anus, vulva, and vagina share common risk factors such as human papillomavirus and smoking.     

Cervical cancer incidence in the United States by area of residence, 1998 2001

OBJECTIVES: To examine differences in cervical cancer incidence rates among women in rural, suburban, and metropolitan areas of the United States. METHODS: This study examined invasive cervical cancer incidence among women in United States counties classified as rural, suburban, and metropolitan for the period 1998-2001. We examined differences in incidence by age, race, Hispanic ethnicity, stage at diagnosis, and poverty level, using the Center for Disease Control and Prevention National Program of Cancer Registries, National Cancer Institute's Surveillance, Epidemiology, and End Results Program and 2000 U.S. Census data. RESULTS: A total of 39,946 cases of cervical cancer were included. Overall, the rates increased among younger women, peaked at ages 40-44 years, remained relatively constant in middle age, and decreased after age 69 years. Incidence rates were lower among residents of metropolitan areas than residents of rural areas, both overall and across groups defined by race, ethnicity, (localized) stage, and poverty level. CONCLUSION: Rural women in the United States have higher cervical cancer incidence rates. Among older women (aged 45-80 years) in whom half of cervical cancers occur, geographic differences largely disappear after controlling for poverty and race. LEVEL OF EVIDENCE: III.     

The relationship of cervical cytology to the incidence of invasive cervical cancer and mortality in Alameda County,California, 1960 to 1974

Cervical cytology as an examination procedure is nearly ideal for discovering unsuspected cervical epithelial malignant changes. A large proportion of women is now being examined periodically with this procedure, and the question now is what effect has this had on the occurrence of invasive cervical cancer and deaths from this disease. Data are available on invasive cervical cancer and its mortality in Alameda County, California, for the 15 years, 1960–1974. Population survey data are available on the experience of women in the County with cervical cytology in 1962 and again in 1973–1974. All cases diagnosed in 1971–1975 were reviewed for a history of cytologic examinations in the 5 years prior to diagnosis. There has been a reduction of over 40% in the occurrence of invasive cervical cancer and mortality among white women in the 10 years 1960–1964 versus 1970–1974. There has been a lesser reduction in both among black women. Twenty-nine percent of women who developed invasive cervical cancer during 1970–1974 had a history of recent negative cytology. This finding indicates that not all invasive cervical cancers have a prolonged in situ stage.