子宫颈腺癌159例预后影响因素分析

目的探讨影响宫颈腺癌预后的高危因素。方法选择1992年1月—2002年12月在中国协和医科大学肿瘤医院初治的159例宫颈腺癌为研究对象,收集其临床病理资料,进行预后影响因素的回顾性分析。结果患者总5年生存率为47 9%。其中临床分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的5年生存率分别为86 1%、56 4%、36 0%、0。复发或转移发生率为29 6%, 复发或转移患者的5年生存率为17 3%。单因素分析显示,肿瘤直径(P=0 009)、临床分期(P<0 01)、血CA125水平(P=0 039)等与预后有关; 27例手术治疗患者中,淋巴结转移(P=0 001)、深肌层浸润(P=0 009)与预后有关。多因素分析显示,只有临床分期、淋巴结转移是独立的预后影响因素。结论临床分期、淋巴结转移是影响宫颈腺癌预后的主要因素,提高早期检出率、改进治疗措施对于提高宫颈腺癌的生存率有重要意义。

Analysis of prognostic factors in 159 cases of cervical adenocarcinoma

OBJECTIVE: To assess prognostic factors in patients with cervical adenocarcinoma. METHODS: Totally 159 cases of primary cervical adenocarcinoma were diagnosed in Cancer Hospital, Peking Union Medical College between 1992 and 2002. Clinical and pathological data including patients'age, delivery, tumor size, stage, grade, histological subtype, Pap smear, serum CA125 and treatment were reviewed. Mean age at presentation was 51.4 years. And the mean follow-up time was 59.8 months. According to the International Federation of Gynecology and Obstetrics (FIGO), patients with stages I-IV accounted for 13.2%, 34.0%, 45.3% and 7.5%, respectively. Survival analysis was carried out using SPSS software version 11.0. RESULTS: The overall 5-year survival rate was 47.9%. It was 86.1%, 56.4%, 36.0% and 0 for stages I, II, III and IV respectively. And 29.6% cases experienced recurrence or distant metastasis. The 5-year survival rate for them was 17.3%. In univariate analysis, tumor size (P = 0.009), stage (P < 0.01) and elevated serum CA125 values (P = 0.039) were significant factors for survival. In the group of 27 cases who received surgery, the survival was significantly poorer for cases with pelvic lymph node metastases (P = 0.001) and deep stromal invasion (P = 0.009). Only stage and pelvic lymph node metastases remained significant predictors for survival when multivariate analysis was performed. CONCLUSIONS: This retrospective study suggests that FIGO stage and pelvic lymph node metastasis are independent factors in prediction of survival in cervical adenocarcinoma. Survival rate remains to be improved.