子宫颈恶性肿瘤年轻患者的临床特点和治疗

目的分析子宫颈恶性肿瘤年轻患者的临床特点、预后及影响预后的因素,探讨年轻患者理想的治疗方案.方法回顾性分析北京协和医院妇产科17年间初治的52例≤35岁年轻的子宫颈恶性肿瘤患者(研究组)和45例≥50岁的子宫颈恶性肿瘤患者(对照组),在临床特点、治疗方式、预后方面的差别.对于保留卵巢的患者应用问卷调查结合血清激素水平测定评价卵巢功能.结果研究组患者以接触性出血和不规则出血为主要临床症状,55.8%的患者合并两种以上症状;人乳头瘤病毒(HPV)感染率为20.5%,高于对照组(P＜0.05);晚期病例(Ⅱb期～Ⅳb期)占30.8%,高于对照组(P＜0.05);组织学类型以鳞癌为主(71.2%),30岁以下患者非鳞癌比例高于对照组(P＜0.05),25岁以下患者都是非鳞癌;组织学分级为G1,G2和G3级者分别是21.2%,54.5%和24.2%;巨块型(肿瘤直径＞4cm)占27.9%,高于对照组(P＜0.05).研究组5年生存率75.7%,明显低于对照组(P＜0.05).肿瘤直径的大小和组织学类型是影响子宫颈恶性肿瘤年轻患者预后的主要因素.结论年轻患者中非鳞癌成分比例高、晚期患者多、预后差,治疗应遵循个体化和人性化原则,尽量保留生育和女性内分泌功能.

Clinical features and treatment of cervical malignant tumor in young women

OBJECTIVE: To evaluate clinical characteristics, prognosis, prognostic factors, and the ideal treatment of the young patients with cervical malignant tumor. METHODS: We analyzed retrospectively 52 cervical malignant tumor patients younger than 35 years (study group) and 45 cervical carcinoma patients older than 50 years (control group) who were admitted in Peking Union Medical College Hospital from 1985 to 2002. The data were analyzed statistically by SPSS10.0. The ovarian functions were evaluated by the questionnaire and the serum sex hormone assay. RESULTS: In study group, the median age was (31.0 +/- 0.6) years old. The most common clinical symptoms were contact bleeding and irregular bleeding; 55.8% of patients had more than one symptom. HPV positive rate was 20.5%, which was higher than control group significantly (P < 0.05). The percentage of advanced stage (stage II b-stage IV b) of disease in study group and control group were 30.8% and 22.2%, respectively, the difference was significant (P < 0.05). The most common histological type was squamous cell carcinoma (71.2%) in study group, while the percentage of non-squamous cell carcinoma (43.8%) in patients younger than 30 years was much higher than control group (P < 0.05). All the histological type was non-squamous cell carcinoma in the patients younger than 25 years. Histological grade showed that G1, G2, and G3 were 21.2%, 54.5%, and 24.2% respectively in study group. The percentage of bulky cervix (tumor diameter > 4 cm) in study group and control group was 27.9% and 2.7% respectively (P < 0.005). The overall 5-year survival rates were 75.7% in study group, lower than control group (P < 0.05). The COX hazards regression model showed histological type (P = 0.003) and bulky cervix (P = 0.001) were of significant prognostic values. CONCLUSIONS: There are more advanced stage carcinoma and non-squamous cell carcinoma patients with poor prognosis in study group. The treatment to younger patients should be concerned individually, as well as preservation of reproductive and female endocrine function should be considered.