宫颈腺癌的临床特征分析

发布时间：2018-08-28 06:29

【摘要】：目的:通过对1996年1月至2015年12月20年间吉林大学第二医院收治的365例宫颈腺癌患者的临床病理特点、术前诊断、治疗方案的选择以及影响预后的相关因素进行回顾性分析,旨在为选择合理的治疗方案提供依据。方法:用EXCEL表格对病例资料进行初步统计,对宫颈腺癌患者的年龄、期别、病理分型、就诊主诉、术前检查、治疗方案、病理结果、生存情况等因素进行初步统计。应用SPSS 19.0系统对数据进行统计学分析,生存情况采用Kaplan-Meier生存分析法、Log-rank检验及COX风险比例模型进行生存及预后影响因素分析,并绘制生存曲线。取α=0.05,p0.05认为有显著性的差异。结果:宫颈腺癌发病年龄主要集中在46-50岁,不同年代之间发病年龄差异无统计学意义(p0.05),未见明显年轻化趋势。术前TCT检出率约为65.6%,HPV-DNA检出率约为64.4%,而TCT联合HPV-DNA检测的阳性率可高达85.11%。宫颈腺癌患者总体3年生存率、5年生存率分别为90.8%、65.5%,平均生存时间为118.858±7.122月,总体3年无进展生存期、5年无进展生存期分别为83.4%、47.7%,平均无进展生存期为87.905±6.308月。Ⅰ期、ⅡA期、ⅡB期、Ⅲ期及以上分期患者5年生存率分别为88.0%、58.7%、33.8%、25%,不同期别生存率差异有显著性(p0.05)。其生存期和复发的主要影响因素包括病理类型、肌层浸润深度、脉管内是否有癌栓浸润、淋巴结转移及卵巢转移情况,其中特殊病理类型、肌层浸润深度≥1/2、脉管内有癌栓浸润、有淋巴结转移及卵巢转移的患者预后较差(p0.05),5年生存率和5年无进展生存率低。年龄、是否保留卵巢对宫颈腺癌的预后无明显影响(p0.05)。是否行术前新辅助化疗对生存期影响无明显区别,与同期别未行新辅助化疗患者相比差异无统计学意义(p0.05)。多因素分析结果显示只有病理类型、FIGO分期是影响宫颈腺癌预后的独立危险因素(p0.05)。另将所有手术患者的相关影响因素纳入多因素分析,结果显示:FIGO分期、术后是否接受辅助性治疗和卵巢转移情况是影响宫颈腺癌预后的独立危险因素(p0.05)。结论:1、宫颈腺癌发病的年龄主要集中在46-50岁年龄段,近20年患者发病年龄未见明显年轻化趋势;2、单独行TCT或HPV检测对宫颈腺癌的诊断阳性率比较低,但是两者联合使用可有效提高宫颈腺癌的检出率;3、对于早期年轻的女性患者可考虑保留其卵巢,以减轻激素缺乏症状;4、ⅠB2-ⅡA2期宫颈腺癌患者术前应用新辅助化疗组与同期别直接手术组相比,生存期及无进展生存期没有明显差异,但NACT可以在术前缩小病灶体积、减轻宫旁浸润,从而降低手术难度、同时减少术后放化疗剂量;5、应加强对有高危因素的宫颈腺癌患者的管理,如特殊类型的宫颈腺癌、肌层浸润深度≥1/2、脉管内有癌栓浸润、有淋巴结转移及卵巢转移等情况,制定具体的个体化治疗,改善生存质量,延长生存期。
[Abstract]:Objective: to analyze retrospectively 365 patients with cervical adenocarcinoma admitted from January 1996 to December 2015 in the second Hospital of Jilin University. The aim is to provide the basis for choosing reasonable treatment plan. Methods: the data of patients with cervical adenocarcinoma were analyzed with EXCEL table. The factors such as age, stage, pathological type, main complaint, preoperative examination, treatment plan, pathological results and survival were analyzed. The data were analyzed by SPSS 19.0 system. The survival conditions were analyzed by Kaplan-Meier survival analysis method and COX risk ratio model, and the survival curve was drawn. The results showed that there was a significant difference between 伪 -0. 05 and 伪-0. 05% (p 0. 05). Results: the onset age of cervical adenocarcinoma was mainly 46-50 years old. There was no significant difference in age between different ages (p0.05), and there was no obvious trend of young age. The detection rate of TCT before operation was 65.6% and that of HPV-DNA was 64.4%, while the positive rate of TCT combined with HPV-DNA could be as high as 85.11%. The overall 3-year survival rate and 5-year survival rate of cervical adenocarcinoma patients were 90.8 and 65.5, respectively. The average survival time was 118.858 卤7.122 months. The overall 3-year progression-free survival period was 83.4%, and the 5-year progression-free survival time was 83.7%. The average progression-free survival time was 87.905 卤6.308.The average survival time was 鈪，

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