年轻妇女子宫颈癌174例临床及预后分析

目的　分析 35岁以下年轻妇女子宫颈癌 (以下简称年轻宫颈癌 )的发病趋势、病因、临床表现、卵巢是否保留以及预后。方法　对 174例年轻宫颈癌患者的临床资料进行回顾性分析。结果　 1991～ 2 0 0 1年我院年轻宫颈癌患者所占比例 (构成比 ,即年轻宫颈癌例数与同期宫颈癌总数之比 )分别为 1 2 %、1 2 %、4 3%、4 2 %、4 6 %、4 5 %、7 3%、9 0 %、10 7%、9 4 %、10 8% ,各构成比总体比较 ,差异有极显著性 (P <0 0 1)。临床症状以接触性阴道出血为主 ,为 10 1例 (5 8 0 % ) ;4 5例患者(2 5 9% )曾被误诊为宫颈炎 ;5 1例患者 (2 9 3% )有性生活紊乱史。 174例患者中 ,原位癌 2 2例 ,临床分期Ⅰa期 3例 ,Ⅰb期 37例 ,Ⅱa期 6 0例 ,Ⅱb期 34例 ,Ⅲb期 18例 ;宫颈鳞癌 14 3例 ,腺癌 2 7例 ,腺鳞癌 4例。手术患者中 ,2 9例淋巴管有累及 (2 9/ 119,2 4 4 % ) ,宫颈肌层浸润深度≥ 1/ 2者为 6 0例 (6 0 /12 2 ,4 9 2 % ) ,人乳头状瘤病毒 (HPV) 16和HPV18感染率为 34% (19/ 5 6 ) ,卵巢转移率为 0 8% (1/ 12 7)。Ⅰ、Ⅱ、Ⅲ期患者 5年生存率分别为 71 6 %、6 0 4 %、13 3% ,分别比较 ,差异均有极显著性 (P <0 0 1)。多因素分析表明 ,临床分期、淋巴管是否累及和宫颈肌层浸润深度是影响预后的独立因素

Analysis of 174 cases with cervical cancer in women under 35 years old

OBJECTIVE: To analyse the prevalence, etiology, presentation, preserving ovary and prognosis of cervical cancer in women under 35 years old. METHODS: The clinical information of 174 patients were retrospectively analysed. RESULTS: The percentage of new cervical cancer cases from 1991 to 2001 was 1.2%, 1.2%, 4.3%, 4.2%, 4.6%, 4.5%, 7.3%, 9.0%, 10.7%, 9.4%, 10.8%, respectively (P < 0.01). Contact bleeding was the main symptom that occurred in 101 cases (101/174, 58.0%). Cervicitis was incorrectly diagnosed in 45 cases (45/174, 25.9%). Sex irregularities occurred in 51 cases (51/174, 29.3%). The number of cases with carcinoma in situ, stage I, stage II, stage III was 22, 40, 94, 18, respectively. There are 29 cases with lymph vascular involvement, 60 with 1/2 or more penetration of the cervical stroma. The incidence of HPV16/18 infection was 34%. The ovarian metastasis was 0.8%. The 5 year survival rate of stage I - III was 71.6%, 60.4% and 13.3%, respectively (P < 0.01). COX regression analysis indicated that stage, lymph-vascular involvement and the depth of tumor infiltration were independently prognostic factors. For patients with one risk factor after radical surgery, the survival of patients with adjuvant radiation therapy and chemotherapy or not was 100%, 88%, respectively (P > 0.05). For patients with two or more risk factors, it was 68%, 1/7, respectively (P < 0.05). CONCLUSIONS: There is an increasing prevalence of cervical cancer in women under 35 years old, which is possibly related to the sexual transition. The preserving ovary in young cervical cancer patients is safe and effective. Patients with late stage, lymph-vascular involvement and deep infiltration of cervical stroma have poor prognosis. Adjuvant treatment may be helpful for patients with 2 or more risk factors after radical surgery.