144例宫颈腺癌临床与预后相关因素分析

探讨浸润性宫颈腺癌患者的临床病理特征、预后及影响因素。方法：对天津医科大学附属肿瘤医院1995年1月至2004年12月间收治的144例浸润性宫颈腺癌临床及病理资料进行回顾性分析。结果：本组患者总体5年生存率为59.0%，其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为80.1%、59.7%、6.3%、0。单因素分析显示非外生型肿瘤、肿瘤直径>4 cm、临床期别增加、病理为黏液腺癌和透明细胞癌、低分化肿瘤的患者预后较差。105例手术治疗患者中，有淋巴结转移和深肌层浸润者预后较差。多因素分析显示：肿瘤形态、临床分期、肌层浸润、淋巴结转移是独立的预后影响因素。结论：影响宫颈腺癌预后的主要因素是肿瘤形态、临床分期、肌层浸润及淋巴结转移；早期诊断及个体化综合治疗对于提高宫颈腺癌患者的生存率至关重要，对具有高危因素的患者提倡给予辅助放化疗，对于年轻的早期患者应保留卵巢。

Analysis of the Clinical and Prognostic Correlation Factors for 144 Cases of Invasive Cervical Adenocarcinoma

To investigate the clinicopathologic features, prognosis, and influencing factors of invasive cervical adenocarcinoma. Methods: Clinical and pathologic data of 144 cases of invasive cervical adenocarcinoma treated in Tianjin Medical University Cancer Institute and Hospital between 1995 and 2004 were retrospectively analyzed. Results: The overall 5-year survival rate was 59.0%, The overall survival rates of patients with stage I, II, III, and IV were 80.1%, 59.7%, 6.3%, and 0, respectively. Univariate analysis demonstrated that the patients suffered from non-exogenic tumors, with diameters exceeding 4 cm and advanced clinical stages. The pathologic diagnosis indicated that the tumors were mucinous adenocarcinoma and clear cell carcinoma, and the patients with poorly differentiated tumor had poorer prognoses. For the 105 patients who underwent surgery, poorer prognoses were seen in those with lymph node metastasis and deep myometrial invasion. Multivariate analysis showed that the shape of tumor, clinical stage, myometrial invasion, and nodal metastasis were independent prognosis-related factors. Conclusion: Early diagnosis and individualized combination therapy are extremely important for improving the survival rate of cervical adenocarcinoma. Adjuvant radiotherapy and chemotherapy should be recommended for patients with high-risk prognostic factors, and the ovary should be reserved for young women with early cervical adenocarcinoma.