| Background and ObjectiveCervical cancer is the most common gynecology malignant tumor, because cervical cancer has the long phase of pre-cancer and the thinprep cytology test (TCT) and high risk human papillomavirus(HPV) DNA test have been used widely, the incidence of this disease has dropped, mortality rate is also dropping. But the incidence rate of young woman cervical cancer (age≤35 year-old) actually gradually increases, the clinical characteristic is also different from who is bigger than 35 years old. The young woman cervical cancer has early clinical phrase, the higher rate of non-squamous carcinoma, the bigger lump body, and the worse prognosis.Besides, the development is rapid and the survival rate is low. Some research found that HPV has intimate relationship with cervical cancer. The relationship between HPV and trend of getting younger of cervical cancer, relationship between HPV and cervical cancer prognosis and HPV vaccine are hot spot nowadays. As prognosis factors of cervical cancer, tumor cells in oxygen level, pelvic lymph node metastasis, tumor size (TS), cervix matrix infiltrates, and the existence of vascular invasion, histologic subtypes, tumor transfered directly involving building, vagina, palace tissue adjacent, HPV and margin involvement are all have prognostic value, besides, they could provide guidance to clinical therapy. But there is no consensus conclusions about independent prognosis factors of cervical cancer.further study is needed.This topic research the reason why young women cervical cancer incidence is increasingly high, in order to find the way to reduce the incidence young women cervical cancer.This topic main research on young woman cervical cancer's clinical characteristic and compare to the patients who is bigger than 35 years old further, screen the facts which influence young woman cervical cancer's prognosis.At last improve the young woman cervical cancer's prognosis.Methods1. The 140 cases cervical cancer patients under 35 years old who were from the Zhengzhou University first affiliated hospital during 2002-2010 years were research group, in control with 140 cases cervical cancer patients whose age was bigger than 35 years old between 2002 and 2005 in this hospital. So as to investigate the clinical and pathological features in young woman.2. The clinicopathologic records of 49 cases of stage I-IIA in the research group who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively analyzed, and the prognostic factors were explored by univariate and multivariate methods.3. The statistical treatment: data was processed by SPSS 17.0 software.Mean comparison between the two groups was analysed by t test, the rate was analysed by chi-square test. Survival rate was calculated by Kaplan-meier, Survival analysis was done by COX regression model, with a=0.05 for a statistically significant standards.Results1. The constituent ratio of young women patients in 2002 year-2010 year is respectively 6.67%,11.35%,11.54%,12.24%,12.30%,13.88%,14.84%, 14.90%,23.07%,26.09%,29.03%.Cervical cancer in young women have been increasing in proportion.2. The first sex age of the research group is younger than the benign gynecologic disease groups, difference is statistically significant (P=0.012). The HPV infection rate of the research group (92.90%) is higher than the control group(61.40%), difference was statistically significant (P=0.007). Pregnancy times of the research group and control group is respectively 2.73±1.644 and 4.15±2.239 difference was not statistically significant (P=1.0000).3. In research group, contact bleeding was the main symptom that occurred in 61.3 percent. In control group, contact bleeding was also the main symptom that occurred in 55.7 percent. The mainly general type of research group was exogenous type occurred in 68.6 percent. In control group, the mainly general type of research group was also exogenous type occurred in 74.3 percent. The clinical stage:I b stage was mainly in research group (42.2%), II a stage was mainly in control group (34.3%).The mainly pathology of type in young women is squamous cell carcinoma, whose ratio is 87.1 percent, and the ratio of adenocarcinoma is 11.4 percent. In control group, mainly pathology of type also is squamous cell carcinoma whose ratio is 88.6 percent, and the ratio of adenocarcinoma is 8.6 percent. Adenocarcinoma proportion of research groupis higher than control group, the difference was statistically significant (P= 0.005). Pelvic lymph node metastases rate of research group was 21.4%, respectively 12.9% in control group, difference was statistically significant (P= 0.026). Vascular transfer rate of research group was 14.3%, respectively 7.1% in control group, difference was statistically significant (P= 0.043).4. Treatment The treatment invlolve surgery, radiation and chemotherapy. Research group and control group operation method are mainly radical hysterectomy and pelvic lymphadenectomy. Keeping ovarian function and sexual life quality is mainly to young group.5. The 5-year survival rate in the younger group and the older group were 70.98 percent and 88.56 percent. The difference was statistically significant (P=O.0276)6. In multivariate Cox analysis, Lymphovascular space involvement, relapse, lymph node metastasis, cervical muscular layer involvement depth, hemoglobin variation in process of concurrent chemoradiation, Pathological types, and stage are the prognostic factors in early stage cervical cancers Conclusions1. Cervical cancer morbidity has the youth oriented tendency. The mainly clinical manifestations of young women cervical cancer is contact hemorrhages;The mainly pathological type of young women cervical cancer is squamous cell carcinoma; Lymph node metastasis rate, vascular transfer rate in young women cervical cancer is higher than elderly group.2. The prognosis was poor in young patients.3. Lymphovascular space involvement,relapse, lymph node metastasis,cervical muscular layer involvement depth, hemoglobin variation in process of concurrent chemoradiation, Pathological types, and stage are the prognostic factors in early stage cervical cancers... |
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