| Objective: Nowdays, cervical carcinoma is the second highest incidencediseases among the female tumor except the breast tumor.There are two typesin cervical carcinoma,cervical adenocarcinoma and cervical squamous cellcarcinoma. AC accounts for10to34percent of cervical carcinoma, And it hasincreasing incidence in recent years, especially among young females. AC inearly stage often has a high misdiagnosis rate. And the cervicaladeno-squamous carcinoma, as a special pathological type,has a survivalrate.Besides, the ovarian preservation has been debated for a long time. At thesame time, surgery and chemotherapy are the main treatment, but there isscope for dispute about whether the neoadjuvant chemotherapy is needed.109cases of AC in the Forth Affiliated Hospital of Hebei Medical University fromMarch2005to April2012were followed, and were analyzed retrospectivelythe clinical features, diagnosis, treatments, prognosis and relapses. And theaim is to improve the level of diagnosis and treatment.Methods: A retrospective analysis and a follow-up of109patients withAC diagnosed by surgery at the Fourth Affiliated Hospital of Hebei MedicalUniversity from March2005to April2012were conducted. The current studyshowed the age was19~70years old, and the median age was47years old.According to the staging criteria of FIGO（2009）, the staging of109cases:stageⅠ76cases, stageⅡ29cases, stage Ⅲ3cases, stageⅣ1case.SPSS19.0was used for statistical analysis. The enumeration data usedχ2test, univariate analysis of prognosis used Kaplan-Meier survival analysis andLog rank test. The multivariate analysis of significant factors use the COXregression model, and the significance judge standard was P＜0.05.Results:1Age Among the109cases of AC, the number of patients whose age not largethan40years old was25(22.9%), and large than40years old was84(77.1%).And the number of patients between40and50years old was46(42.2%),50to60years old was35（32.1%）,and larger than60years old was3（2.6%）. Thedata showed that patients between40and50years old had the largestmorbidity.2MenstruationThe number of premenopause females was79（72.5%）, andpostmenopause was30（27.5%）. This showed AC often occurs topremenopause females. Among109cases of receiving surgery, the number ofpremenopause females of early stage was6（862.4%）, and postmenopause was23(21.1%); the number of premenopause females of late stage was11（10.1%）,and postmenopause was7（6.4%）. The menstruation of the early and late stagehad no significant difference(P＞0.05).3Reproductive HistoryThe number of patiernts who reproductived no more than2times was75(68.8%)，and more than2times was34(31.2%).。Among All the109patients,the number of early stage patients with reproductive at most2timeswas68(62.4%),more than2times was23(21.1%); the number of late stagepatients with reproductive at most2times was7(6.4%),more than2times was11(10.1%). The reproductive history of the early and late stage had significantdifference(r=0.287，P＜0.05).4Clinical manifestation and SignsThe clinical manifestations of early stage AC are not typical. The numberof patients whose manifestation was abnormal vaginal bleeding was98(89.9%), abnormal vaginal discharge was43(39.4％),and it showed abnormalvaginal bleeding and discharge were more-seen symptoms.5Preoperative diagnosisAmong109cases of AC,106cases were diagnosed by cervical biopsy.3cases were diagnosed by cervical conization.27patients were refered to detectHPV,21cases were positive for it.The infection rate was77.8%.Among the18 cases who were searched had TCT examination,7cases were diagnosed asbenign disease,the misdiagnosis rate was38.9%.6Survival rate6.1The one-year overall survival rate was98.2%(107/109), three-yearoverall survival rate was78.4%(69/88), five-year overall survival rate was76.4%(26/34).6.2The survival rate between early stage and late stage after surgery hadstatistically difference (P<0.05), and that showed the prognosis survival of ACwas related to clinical stage.6.3The survival rate between≤40-year-old cases and＞40-year-oldcases after surgery had statistically difference (P<0.05),and it indicated theprognosis survival after surgery of AC was related to age.6.4The survival rate between cases who had reproductived more than2times and no more than2times after surgery had statistically difference(P<0.05), and that showed the prognosis survival after surgery of AC wasrelated to reproductive history.6.5The survival rate after surgery between premenopause andpostmenopause patients had no statistically difference (P＞0.05).6.6The survival rate after surgery among high grade,middle grade andlow grade AC patients had no statistically difference (P＞0.05).6.7The survival rate after surgery between adeno-squamous carcinomaand non-adeno-squamous carcinoma cases had no statistically difference (P＞0.05).6.8The survival rate after surgery between patients whose lump sizeexceed4cm and no more than4cm after surgery had statistically difference(P<0.05), and that showed the prognosis survival after surgery of AC wasrelated to lump size.6.9The survival rate after surgery between cases that the depth ofmyometrial invasion＞1/2and≤1/2after surgery had statistically difference(P<0.05), and that showed the prognosis survival after surgery of AC wasrelated to the depth of myometrial invasion. 6.10The survival rate after surgery between cases of positive andnegative surgical margin had no statistically difference (P＞0.05).6.11The survival rate after surgery between cases of positive andnegative vascular invasion had no statistically difference (P＞0.05).6.12The comparison of survival rate between patients sweeping pelviclymph nodes and patients without lymph sweeping had no statisticallydifference(P＞0.05).6.13The survival rate after surgery of patients reserving ovaries andpatients without ovaries reservation had no statistically difference (P＞0.05).Among the patients of early stage, compared the survival rate after surgerybetween the two, the difference had no statistically significance(P＞0.05).6.14The survival rate of laparotomy and laparoscopic surgery of AC hadno statistically difference (P＞0.05).6.15The survival rate of surgery alone and surgery combined withadjuvant treatments had no statistically difference (P＞0.05).Among patientswith risk factors, compared the survival rate after surgery between the two，thedifference had statistically significance(P<0.05).6.16In101patients who had pelvic lymph nodes sweeped, the survivalrate after surgery between lymph node metastasis and no lymph nodemetastasis had statistically difference (P<0.05), and that showed the prognosissurvival after surgery of AC was related to lymph node metastasis.7DFS after surgery7.1The DFS after surgery between the early stage and the late aftersurgery had statistically significant (P<0.05).7.2The DFS after surgery among high grade,middle grade and low gradeAC patients had no statistically difference (P＞0.05).7.3The DFS after surgery between adeno-squamous carcinoma andnon-adeno-squamous carcinoma cases had no statistically difference (P＞0.05).7.4The DFS after surgery between patients whose lump size exceed4cmand no more than4cm had statistically difference (P<0.05), and that showed the DFS after surgery of AC was related to lump size.7.5The comparison of the DFS after surgery between cases that the depthof myometrial invasion＞1/2and≤1/2had statistically difference(P＜0.05).and that showed the DFS after surgery of C AC was related tohe depth ofmyometrial invasion.7.6The comparison of the DFS after surgery between cases of positiveand negative vascular invasion had no statistically difference (P＞0.05).7.7The DFS after surgery of patients reserving ovaries and patientswithout ovaries reservation had no statistically difference (P＞0.05). Amongthe patients of early stage, the DFS after surgery of patients reserving ovariesand patients without ovaries reservation had no statistically difference (P＞0.05).7.8The DFS of laparotomy and laparoscopic surgery had no statisticallydifference (P＞0.05).7.9Among the patients with risk factors, the DFS after surgery of surgeryalone and surgery combined with adjuvant treatments had no statisticallydifference (P＞0.05).7.10The DFS after surgery between lymph node metastasis and nolymph node metastasis had statistically difference (P<0.05), and that showedthe DFS after surgery of AC was related to lymph node metastasis.8Multiple-factor analysisUse the COX regression model to analyze the effect of the age, stage,reproductive history, lump size, the depth of myometrial invasion and thelymph node metastasis to survival, and the result showed the lump size wasstatistically independent factor(P<0.05). The mortality risk of patients withlump size exceeding4cm was higher than patients of lump size no more than4cm.Use the COX regression model to analyze the effect of the stage, lumpsize, the depth of myometrial invasion and the lymph node metastasis torecurrence, and the result showed the lump size was statistically independentfactor(P<0.05). The relapse risk of patients with lump size exceeding4cm was higher than patients of lump size no more than4cm.Conclusion:1In this study, patients who were40to50years old made up42.2%ofAC.It meant that40to50years old AC patients had a higher morbidity.2In this study,72.5%patients were premenopause,89.9%patients werevagina abnormal bleeding,and39.4%patients were vagina abnormal discharge;the morbidity of simple adenocarcinoma was54.1%；the study showed thatAC always happened on the premenopause female, and vagina abnormalbleeding and discharge were most common clinical symptom，and the cervicalsimple adenocarcinoma had a high morbidity.4The early stage(Ⅰ A2, ⅠB and ⅡA)young patients,who had none riskfactors,could reserve ovaries.At the same time,they should be informed therisk of the ovary metastasis.5For the patients with risk factors, concomitant radiochemotherapycould improve the survival rate,but it made no difference with the DFS aftersurgery.6The result of COX regression analysis was that the lump size wasstatistically independent factor, it influenced not only the survival rate but alsothe DFS. Therefore the patients with the lump size exceeding4cm should beheld in great account. |
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