摘要
目的探讨宫颈胃型腺癌(gastric-type endocervical adenocarcinoma,G-EAC)的临床特征、诊疗及预后。方法回顾性分析2017年1月—2022年6月郑州大学第一附属医院收治的30例G-EAC患者的临床资料,并对患者进行随访,评估预后。结果30例G-EAC中,I期10例,Ⅱ期2例,III期15例,Ⅳ期3例。HPV阳性率为18.2%,TCT阳性率为52.2%。仅11例术前确诊为G-EAC,8例因宫颈活检病理确诊,3例因宫颈锥形切除术后病理确诊;15例术前诊断为宫颈腺癌,1例误诊为子宫内膜癌,1例误诊为原发性卵巢癌,2例因良性病变行子宫及双侧附件切除术,均于术后病理确诊为G-EAC。61.5%患者病变累及宫体,52.0%伴有淋巴结转移,38.5%见脉管内癌栓,26.9%伴有卵巢转移,23.1%阴道受累,15.4%出现神经侵犯,7.7%病变侵犯直肠。随访至2022年9月,6例死于本病,4例复发,8例未控,5例失访;5年生存率56.7%,5年无进展生存率44.7%。结论G-EAC早期诊断困难,误诊率高,易发生浸润和转移,预后差,需重视阴道长期排液的症状及宫颈部位影像学特征,结合组织病理学形态和免疫组织化学染色可明确诊断,做到早诊早治,降低误诊率,以期改善预后。
Objective To explore the clinical features,diagnosis,treatment and prognosis of gastric-type endocervical adenocarcinoma(G-EAC).Methods The clinical,pathological,therapeutic and survival data of 30 patients with G-EAC admitted to the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2022 were retrospectively analyzed.In addition,all patients were followed up to assess the prognosis.Results Among the 30 G-EAC patients,there were 10 cases in stage I,2 cases in stage II,15 cases in stage III,and 3 cases in stage IV.The HPV positivity rate was 18.2%,and the TCT positivity rate was 52.2%.Only 11 cases were diagnosed as G-EAC before the operation,including 8 cases were diagnosed by pathology of cervical biopsy and 3 cases were diagnosed by pathology after cervical conectomy.However,15 cases were diagnosed as cervical adenocarcinoma before surgery.1 case was misdiagnosed as endometrial carcinoma and 1 case was misdiagnosed as original ovarian cancer before the operation.2 cases were diagnosed as G-EAC after the operation of hysterectomy and bilateral salpinx oophorectomy.61.5% of patients had lesions involving the uterine body,52.0% with lymph node metastasis,38.5% with intravascular cancer thrombus,26.9% with ovarian metastasis,23.1% with vaginal involvement,15.4% with nerve invasion,and 7.7% with lesions invading the rectum.Up to September 2022,the tumor was uncontrolled in 8 cases and relapsed in 4 cases and 6 patients had tumor-related death.The 5-year overall survival rate was 56.7% and the 5-year progression free survival rate was 44.7%.Conclusion G-EAC is difficult to diagnose early,proven to infiltration and metastasis,and has a high misdiagnosis rate and poor prognosis.It is necessary to pay attention to the long-term vaginal discharging and cervical imaging features.Immunohistochemical markers can help to clarify the diagnosis,so as to reduce the misdiagnosis rate,achieve early treatment and improve the prognosis.
作者
苗梦薇
赵倩
李改玲
田彦鹏
MIAO Meng-wei;QIAO Zhao;LI Gai-ling;TIAN Yan-peng(Department of Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《医药论坛杂志》
2023年第12期75-79,84,共6页
Journal of Medical Forum
关键词
宫颈癌
宫颈胃型腺癌
诊断
治疗
预后
Cervical cancer
Gastric-type adenocarcinoma
Diagnosis
Treatment
Prognosis
