| At present,in developing countries,cervical cancer is still one major cancer that harms women health.It needs to increase the popularity to undergo the screening of cervical cancer,meanwhile,a higher requirement is needed for cervical cancertreatment.In order to improve treatment outcome and quality of life,it is supposed to do further research on the clinical pathology factors of cervical cancer patients.PartⅠ Significance of the factors associated with parametrial involvement in stage ⅠB to ⅡA cervical cancerAt present,for most of early-stage patients with cervical cancer,conservative surgery has been paid more and more attention to reduce postoperative complications,improve postoperative quality of life.the operations in surgical treatments of cervical cancer are determined according to the tumor stage only,so patients at the same tumor stage would receive the same operation.However,the staging of cervical cancer is clinical staging that does not include image findings and pathologic results,that means there may be some imperfections in the operative treatments of cervical cancer.On one hand,for some patients,the extent of surgery may be too large.Some studies suggested that,for patients with stage Ⅰ B to ⅡA cervical cancer,there is no difference in OS,DFS,and RR between the patients undergoing class Ⅱ radical hysterectomy and the patients undergoing class Ⅲ radical hysterectomy,but the mean operative time is significantly shorter and the incidence of surgical complications reduces in the group of patients undergoing class Ⅱ hysterectomy.Moreover,some studies pointed out that modified radical hysterectomy is less radical and nerve-sparing.On the other hand,for some patients,the extent of surgery may not be enough.The surgery of cervical cancer includes a range of resection of parametrium.The aim of parametrectomy is to completely remove occult lesions and reduce the risk of recurrence.Many researchers have found that the patterns of parametrial involvement of cervical cancer are diverse.Some studies found 50%of the parametrial lesions are not connected with the primary lesions,and are instead distributed over the parametrium randomly.If the patients with the same disease stage receive the same operation,the discontinuous lesions of parametrial involvement may not be removed completely and relapse may occur.Therefore,parametrial resection is very critical in the surgery of cervical cancer.It is also a difficult procedure that directly affects the results of operations,and is related to most of the postoperative complications of cervical cancer.If factors associated with parametrial involvement are determined,the right extent of parametrial resection can be determined based on the presence or absence of risk factors.Thus patients can be treated with personalized operation to have the lesion completely removed,surgery-related morbidity is reduced,and the quality of life after surgery is improved.ObjectiveThe aim is to explore the factors associated with parametrial involvement(PI)in patients with stage Ⅰ B to ⅡA cervical cancer.Materials and methodsMedical records of 507 patients were reviewed.Nine factors as age,cell differentiation,clinical stage,lymph node metastasis(LNM),lymph-vascular space invasion(LVSI),depth of stromal invasion,histological type,uterine body involvement,and tumor size were analyzed to screen the factors related to PI,univariate analysis was operated by Chi-square test and multivariate analysis was operated by logistic regression analysis.A P value less than 0.05 indicated statistical significance.SPSS 16.0 statistical software was used to complete the operation.Results1.parametrial involvement was revealed in 46(9.1%)of the 507 patients.Of the subjects with parametrial involvement,9(19.6%)had bilateral parametrial involvement,whereas 37(80.4%)only had unilateral parametrial involvement.23(50%)only had direct tumor extension,4(8.7%)only had discontinuous malignant cells,6(13.0%)only had positive parametrial lymph nodes,6(13.0%)only had tumor emboli within the lymph vascular channels,4(8.7%)had direct tumor extension and discontinuous malignant cells,1(2.2%)had direct tumor extension,discontinuous malignant cells and tumor emboli within the lymph vascular channels,1(2.2%)had both direct tumor extension and positive tumor emboli within the lymph vascular channels,and 1(2.2%)had direct tumor extension,positive parametrial lymph nodes,and tumor emboli within the lymph vascular channels in the parametrial tissue.2.The result of univariate analysis by Chi-square test indicated that depth of stromal invasion,LVSI,LNM,and uterine body involvement were associated with parametrial involvement in stage Ⅰ B to ⅡA cervical cancer(P<0.05 for all).3.The result of multivariate analysis by binary logistic regression analysis showed that uterine body involvement and LNM were the independent factors of parametrial involvement in stage Ⅰ B to ⅡA cervical cancer.With the exception of depth of stromal invasion,LNM,and uterine body involvement,other factors can be assessed before hysterectomy.Multivariate analysis of these factors revealed that non-squamous histological type and LVSI were the independent factors of parametrial involvement.4.The incidence of PI in the patients with no LVSI and squamous cancer was 6.97%.When the patients with inner 1/3 stromal invasion were stratified into those with squamous cancer and no LVSI,the incidence of PI was 1.17%.The incidence of PI in the patients with LVSI and non-squamous cancer was 33.33%.Conclusions1.The patterns of parametrial involvement of patients with cervical cancer are diverse and unpredictable.2.Depth of stromal invasion,LVSI,LNM,and uterine body involvement were associated with parametrial involvement in stage ⅠB to ⅡA cervical cancer.3.Uterine body involvement and LNM were the independent factors of parametrial involvement in stage Ⅰ B to ⅡA cervical cancer.4.The patients with inner 1/3 stromal invasion,no LVSI,and squamous histological type may be considered for less radical surgery.The patients with non-squamous histological type and LVSI may be considered for radical hysterectomy including a complete resection of parametrium.Part Ⅱ A comparison of the prognosis between adenocarcinoma and squamous cell carcinoma in stage ⅠB to ⅡA cervical cancerCurrently,there is no difference between the treatment of cervical squamous cell carcinoma and that of cervical adenocarcinoma.However,more and more evidences suggested that the biological behavior,epidemiology,prognostic factors,and treatment outcome of adenocarcinoma differ from those of squamous cell carcinoma.The influences of histological subtypes of cervical cancer on prognosis remain controversial.Most studies have shown that cervical adenocarcinoma has a poorer prognosis than cervical squamous cell carcinoma,moreover,there are studies showing that,with the increasing of clinical stage,this difference is more obvious.However,there are also studies which found that there is no significant difference between the prognosis of adenocarcinoma and that of squamous cell carcinoma in early-stage cervical cancer.Some studies have found that,compared with squamous cell carcinoma,adenocarcinoma is prone to lymph node metastasis,ovarian metastasis,and blood transfer,therefore,the prognosis of adenocarcinoma is poorer than that of squamous cell carcinoma.There are studies found that radioresistance may be one of the reasons of poor prognosis for adenocarcinoma patients.However,the treatment of adenocarcinoma does not differ from that of squamous cell carcinoma at present.There is no evidence to support the idea that the treatment of adenocarcinoma should be different from that of squamous cell carcinoma.Therefore,in order to provide more suitable treatment for patients with cervical adenocarcinoma,it is necessary to explore the differences in prognosis,lymph node metastasis,and ovarian metastasis between adenocarcinoma and squamous cell carcinoma.ObjectiveThe aim is to explore the differences in prognosis and ovarian metastasis between adenocarcinoma and squamous cell carcinoma in stage ⅠB to ⅡA cervical cancer by the retrospective analysis of the clinical and pathological data of 810 patients.Materials and methodsThe subjects of the Part Ⅰ study continued to be followed up,and the subjects of the Part≡ study included new patients treated in 2014 to 2015.Criteria for inclusion into the study:the subjects’ primary treatments were class Ⅲ hysterectomy and systematic lymphadenectomy,their medical records,pathological data,and follow-up data were complete,the stages of their tumors were ⅠB-ⅡA,and the histological types of their tumors were squamous cell carcinoma or adenocarcinoma.A total of 810 patients met the standard.The clinical and pathological data of the subjects were collected,verified,summarized and sorted out.The prognostic factors of the subjects were analyzed by univariate and multivariate analysis.The differences in prognosis and ovarian metastasis between the subjects with squamous cell carcinoma and the subjects with adenocarcinoma were analyzed.The mean age of the two groups was compared with t test.Clinical and pathological characters of the two groups were compared using Chi-square test.Kaplan-Meier survival analysis was used in subjects’ survival analysis and univariate analysis of prognostic factors.The differences of overall survival,survival function between the two groups were analyzed by Log-rank test.The multivariate analysis of prognostic factors was conducted by Cox proportional hazards regression model.A P value less than 0.05 indicated statistical significance.SPSS 16.0 statistical software was used to complete the operation.Results1.The mean age was about 2.65 years younger in patients with adenocarcinoma than in patients with squamous cell carcinoma(44.31±9.061 vs.46.96±9.839 years old;P ＝0.01<0.05).The incidence of LUSI in patients with squamous cell carcinoma was significantly higher than that in patients with adenocarcinoma(23.90%vs.8.59%;P=0.000<0.05).The incidence of poor cell differentiation in patients with squamous cell carcinoma was significantly higher than that in patients with adenocarcinoma(54.25%vs.28.91%;P=0.000<0.05).There were no differences in the comparison of the other clinical and pathological characters of the two groups(P>0.05).2.There were a total of 810 subjects,61 cases died,the 5-year cumulative survival rate of the 810 subjects was 86.7%.The results of univariate analysis of prognostic factors showed that cell differentiation,clinical stage,lymph node metastasis,ovarian metastasis(OM),parametrial involvement,LVSI,depth of stromal invasion,and tumor size were related to the prognosis of the patients with stage ⅠB-ⅡAcervical cancer(P<0.05),while histological type(squamous cell carcinoma or adenocarcinoma),age,and uterine body involvement were not related to the prognosis of the patients with stage ⅠB-ⅡA cervical cancer(P>0.05).3.The results of multivariate analysis of prognostic factors showed that cell differentiation,clinical stage,and lymph node metastasis were the independent prognostic factors for the patients with stage ⅠB-ⅡA cervical cancer.4.In all the subjects,the 5-year cumulative survival rate was 87.3%for the patients with squamous cell carcinoma,and 82.4%for the patients with adenocarcinoma,respectively.There was no statistically significant difference in the overall survival of the two groups(P>0.05).In the subjects with stage ⅠB cancer,the 5-year cumulative survival rate was 89.8%for the patients with squamous cell carcinoma,and 89.2%for the patients with adenocarcinoma,respectively.There was no significant difference in the overall survival of the two subgroups(P>0.05).In the subjects Avith stage ⅡA cancer,the 5-year cumulative survival rate was 79.4%for the patients with squamous cell carcinoma,and 61.1%for the patients with adenocarcinoma,respectively.There was no significant difference in the overall survival of the two subgroups(P>0.05).In the subjects with lymph node metastasis,the 5-year cumulative survival rate was 65.4%for the patients with squamous cell carcinoma,and 49.6%for the patients with adenocarcinoma,respectively.There was no significant difference in the overall survival of the two subgroups(P>0.05).In the subjects with poor cell differentiation,the 5-year cumulative survival rate was 81.2%for the patients with squamous cell carcinoma,and 77.5%for the patients with adenocarcinoma,respectively.There was no significant difference in the overall survival of the two subgroups(P>0.05).5.In the 810 subjects,645 patients(532 cases of squamous cell carcinoma +113 cases of adenocarcinoma)underwent unilateral or bilateral ovariectomy,and 10 patients of them had ovarian metastasis(1.55%).The incidence of ovarian metastasis was 9(1.69%)for the patients with squamous cell carcinoma,and 1(0.88%)for the patients with adenocarcinoma,respectively.There was no significant difference(P>0.05).In the patients with cervical adenocarcinoma,the 5-year cumulative survival rate was 75%for the patients with unilateral or bilateral ovarian retention,and 86.6%for the patients with bilateral ovariectomy,respectively.There was no significant difference in the overall survival of the two subgroups(P>0.05).Conclusions1.Cell differentiation,clinical stage,lymph node metastasis,ovarian metastasis,parametrial involvement,LVSI,depth of stromal invasion,and tumor size are related to the prognosis of the patients with stage ⅠB-ⅡA cervical cancer.2.Cell differentiation,clinical stage,and lymph node metastasis are the independent prognostic factors for the patients witih stage ⅠB-ⅡA cervical cancer.3.Histological type(squamous cell carcinoma or adenocarcinoma)is not related to the prognosis of the patients with stage ⅠB-ⅡA cervical cancer.For stage ⅠB-ⅡAcervical cancer,there was no significant difference in the prognosis between the patients with adenocarcinoma and the patients with squamous cell carcinoma,even with the increasing of clinical stage.4.The incidence of ovarian metastasis in the patients with stage ⅠB-ⅡA cervical adenocarcinoma was low,the ovaries of some premenopausal patients may be preserved. |
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