宫颈透明细胞癌13例临床分析
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摘要
目的:探讨宫颈透明细胞癌的临床特点、治疗及预后。方法:回顾性分析2013年4月—2017年12月郑州大学第一附属医院收治的13例原发宫颈透明细胞癌患者的临床资料及随诊资料,分析其临床特征、病理特点、治疗方案及预后情况。结果:13例患者平均年龄(53.6±13.9)岁,9例(69.2%)大于40岁,4例(30.8%)小于40岁,其中2例青少年患者。临床分期:Ⅰ期6例(46.15%),Ⅱ期6例(46.15%),Ⅲ期1例(7.7%);12例接受手术+放化疗,其中3例行新辅助化疗,9例术后放疗和(或)化疗,1例单纯放疗;中位随访时间24个月(6～60个月),4例死亡,2例多发转移,第1、2、5年累积生存率分别为12/13、11/13和9/13。结论:宫颈透明细胞癌发病率低,临床表现无特异性,伴淋巴结转移者预后极差,手术加放化疗的个体化综合治疗方案能明显改善患者病情及预后。
Objective:To discuss the clinical and pathological characteristics, therapy and prognosis of clear cell adenocarcinoma of cervical(CCAC). Methods: We performed a retrospective review of 13 patients with CCAC who were diagnosed and treated at the First Affiliated Hospital of Zhengzhou University from April 2013 to December 2017. Result: The age of the patients was(53.6±13.9) years,of which 9(69.2%) were older than 40 years and 4(30.8%) were younger than 40 years, 2 were adolescents. The International Federation of Gynecology and Obstetrics stage: 46.15%( n=6) stage Ⅰ, 46.15%(n=6)stage Ⅱ, 7.7%(n =1) stage Ⅲ. Twelve patients underwent surgery followed by radiotherapy and chemotherapy, including 3 patients treated by neoadjuvant chemotherapy, 9 postoperative adjuvant radiotherapy and/or chemotherapy. One patient was treated by radiotherapy alone. The median follow-up time was 24 months(6-60 months). 4 patients died and 2 patients had multiple metastases. The 1-year, 2-year and 5-year survival rates were 12/13 、11/13 and 9/13, respectively. Conclusions:CCAC has low incidence, nonspecific clinical manifestations and poor prognosis with lymph node metastasis. The individualized comprehensive treatment of surgery followed by radiotherapy and chemotherapy can significantly improve the patient′ s condition.
Objective:To discuss the clinical and pathological characteristics, therapy and prognosis of clear cell adenocarcinoma of cervical(CCAC). Methods: We performed a retrospective review of 13 patients with CCAC who were diagnosed and treated at the First Affiliated Hospital of Zhengzhou University from April 2013 to December 2017. Result: The age of the patients was(53.6±13.9) years,of which 9(69.2%) were older than 40 years and 4(30.8%) were younger than 40 years, 2 were adolescents. The International Federation of Gynecology and Obstetrics stage: 46.15%( n=6) stage Ⅰ, 46.15%(n=6)stage Ⅱ, 7.7%(n =1) stage Ⅲ. Twelve patients underwent surgery followed by radiotherapy and chemotherapy, including 3 patients treated by neoadjuvant chemotherapy, 9 postoperative adjuvant radiotherapy and/or chemotherapy. One patient was treated by radiotherapy alone. The median follow-up time was 24 months(6-60 months). 4 patients died and 2 patients had multiple metastases. The 1-year, 2-year and 5-year survival rates were 12/13 、11/13 and 9/13, respectively. Conclusions:CCAC has low incidence, nonspecific clinical manifestations and poor prognosis with lymph node metastasis. The individualized comprehensive treatment of surgery followed by radiotherapy and chemotherapy can significantly improve the patient′ s condition.
引文
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[12]Abu-Rustum NR,Su W,Levine DA,et al.Pediatric radical abdominal trachelectomy for cervical clear cell carcinoma:a novel surgical approach[J].Gynecol Oncol,2005,97(1):296-300.
[13]Lester FC,Farmer DL,Rabban JT,et al.Radical trachelectomy for clear cell carcinoma of the cervix in a 6-year old:a case report,review,and description of the surgical technique[J].J Pediatr Surg,2010,45(8):E1-E5.
[14]Jiang X,Jin Y,Li Y,et al.Clear cell carcinoma of the uterine cervix:clinical characteristics and feasibility of fertility-preserving treatment[J].Onco Targets Ther,2014,7:111-116.
[15]Thomas MB,Wright JD,Leiser AL,et al.Clear cell carcinoma of the cervix:a multi-institutional review in the post-DES era[J].Gynecol Oncol,2008,109(3):335-339.
[16]Yang L,Zheng A,Zhang X,et al.Clear Cell Carcinoma of the Uterine Cervix:A Clinical and Pathological Analysis of 47 Patients Without Intrauterine Diethylstilbestrol Exposure[J].Int J Gynecol Cancer,2017,27(5):1009-1014.
[17]Singh S,Redline R,Resnick KE.Fertility-sparing management of a stage IB1 small cell neuroendocrine cervical carcinoma with radical abdominal trachelectomy and adjuvant chemotherapy[J].Gynecol Oncol Rep,2015,13:5-7.
[2]Hanselaar A,van Loosbroek M,Schuurbiers O,et al.Clear cell adenocarcinoma of the vagina and cervix.An update of the central Netherlands registry showing twin age incidence peaks[J].Cancer,1997,79(11):2229-2236.
[3]Pirog EC,Kleter B,Olgac S,et al.Prevalence of human papillomavirus DNA in different histological subtypes of cervical adenocarcinoma[J].Am J Pathol,2000,157(4):1055-1062.
[4]谭玉婷,张莘,林仲秋,等.子宫颈原发性透明细胞癌五例临床分析[J].中华妇产科杂志,2008,43(2):120-123.
[5]Hiromura T,Tanaka YO,Nishioka T,et al.Clear cell adenocarcinoma of the uterine cervix arising from a background of cervical endometriosis[J].Br J Radiol,2009,82(973):e20-e22.
[6]Reich O,Tamussino K,Lahousen M,et al.Clear cell carcinoma of the uterine cervix:pathology and prognosis in surgically treated stage IB-IIB disease in women not exposed in utero to diethylstilbestrol[J].Gynecol Oncol,2000,76(3):331-335.
[7]蒋湘,金滢,李艳,等.宫颈透明细胞癌28例临床分析[J].基础医学与临床,2013,33(3):264-269.
[8]楼宝阳,陈海燕.子宫颈透明细胞癌34例临床分析[J].中华肿瘤杂志,2000,22(4):339-340.
[9]涂云霞,胡小青,华金仁,等.宫颈透明细胞癌50例临床病例分析[J].现代肿瘤医学,2017,25(10):1609-1612.
[10]曹泽毅.中华妇产科学[M].2版.北京:人民卫生出版社,2004:2061-2066,2324-2332.
[11]Singh P,Nicklin J,Hassall T.Neoadjuvant chemotherapy followed by radical vaginal trachelectomy and adjuvant chemotherapy for clear cell cancer of the cervix:a feasible approach and review[J].Int JGynecol Cancer,2011,21(1):137-140.
[12]Abu-Rustum NR,Su W,Levine DA,et al.Pediatric radical abdominal trachelectomy for cervical clear cell carcinoma:a novel surgical approach[J].Gynecol Oncol,2005,97(1):296-300.
[13]Lester FC,Farmer DL,Rabban JT,et al.Radical trachelectomy for clear cell carcinoma of the cervix in a 6-year old:a case report,review,and description of the surgical technique[J].J Pediatr Surg,2010,45(8):E1-E5.
[14]Jiang X,Jin Y,Li Y,et al.Clear cell carcinoma of the uterine cervix:clinical characteristics and feasibility of fertility-preserving treatment[J].Onco Targets Ther,2014,7:111-116.
[15]Thomas MB,Wright JD,Leiser AL,et al.Clear cell carcinoma of the cervix:a multi-institutional review in the post-DES era[J].Gynecol Oncol,2008,109(3):335-339.
[16]Yang L,Zheng A,Zhang X,et al.Clear Cell Carcinoma of the Uterine Cervix:A Clinical and Pathological Analysis of 47 Patients Without Intrauterine Diethylstilbestrol Exposure[J].Int J Gynecol Cancer,2017,27(5):1009-1014.
[17]Singh S,Redline R,Resnick KE.Fertility-sparing management of a stage IB1 small cell neuroendocrine cervical carcinoma with radical abdominal trachelectomy and adjuvant chemotherapy[J].Gynecol Oncol Rep,2015,13:5-7.