【作者】 徐杰；

【导师】 刘健；

【作者基本信息】 蚌埠医学院 ， 妇产科学（专业学位）， 2021， 硕士

【摘要】 目的:探究IB1-IIA2期宫颈鳞癌(Squamous Cell Carcinoma,SCC)与腺癌(Adenocarcinoma,AC)患者的病理特征、预后影响因素及其差异,期望为今后临床上的治疗提供经验与依据。方法:回顾性分析2016年1月至2019年1月在蚌埠医学院第一附属医院接受宫颈癌根治术治疗的IB1-IIA2期宫颈SCC和AC患者的260例临床病理资料,比较两者的病理特征、预后影响因素及差异。结果:1.260例宫颈癌患者其中宫颈鳞癌患者197例(76%),宫颈腺癌63例(24%),SCC患者的年龄范围为(27-72)岁,AC的年龄范围为(21-74)岁,SCC与AC患者的平均年龄±标准差分别为49.95±8.62岁,49.71±9.28岁(t=0.189,P=0.850),两者差异无统计学意义;SCC以外生菜花型为主,AC以内生浸润型为主(P<0.05);两者的肿瘤大小、浸润深度、细胞分化差异无统计学意义;2.IB1-IIA2期宫颈SCC与AC 3年无进展生存期(Progression-free Survival,PFS)分别为:94.6%、89.4%,差异无统计学意义,单因素Log-rank分析示:临床分期、肿瘤大小,浸润深度均是IB1-IIA2期宫颈SCC和AC预后影响因素,根据预后影响因素进一步分析,IB1-IIA2期宫颈SCC与AC患者3年PFS在肿瘤大小、浸润深度、临床分期上差异均无统计学意义;将临床分期、肿瘤大小,浸润深度纳入多因素Cox回归模型分析示:临床分期是IB1-IIA2期宫颈SCC与AC患者预后的独立危险因素(P<0.05)。结论:1.IB1-IIA2期宫颈鳞癌与腺癌的病理特征大致相似,宫颈鳞癌以外生菜花型为主,宫颈腺癌以内生浸润型为主,易漏诊,对于可疑的内生型宫颈病变,应进行宫颈管搔刮术(Endocervical Curettage,ECC);2.根据术后的中危因素,采取合适的术后辅助治疗,IB1-IIA2期宫颈鳞癌与腺癌患者可获得相同的预后,临床分期是IB1-IIA2期宫颈鳞癌与腺癌预后的独立危险因素。更多还原

【Abstract】 Purpose: To explore the pathological characteristics,prognostic factors and differences of patients with IB1-IIA2 stage squamous cell carcinoma(Squamous Cell Carcinoma,SCC)and adenocarcinoma(AC),and hope to provide experience and basis for future clinical treatment.Methods: A retrospective analysis of the clinicopathological data of 260 patients with IB1-IIA2 cervical SCC and AC who underwent radical resection of cervical cancer in the First Affiliated Hospital of Bengbu Medical College from January 2016 to January 2019,and compared the pathological characteristics of the two.Factors and differences in prognosis.Results: 1.260 cases of cervical cancer patients include 197 cases of cervical squamous cell carcinoma(76%),63 cases of cervical adenocarcinoma(24%),the age range of SCC patients is(27-72)years old,and the age range of AC is(21-74)The average age ± standard deviation of patients with SCC and AC was 49.95±8.62 years old and 49.71±9.28 years old(t=0.189,P=0.850).The difference between the two was not statistically significant;the lettuce types other than SCC were mainly flowers,and AC Mainly endogenous infiltrating type(P<0.05);there was no statistically significant difference in tumor size,depth of invasion,and cell differentiation between the two;2.Three-year progression-free survival(Progression-free Survival)between stage IB1-IIA2 cervical SCC and AC,PFS)were 94.6% and 89.4% respectively,the difference was not statistically significant.Single factor Log-rank analysis showed that clinical stage,tumor size,and depth of invasion are all prognostic factors for cervical SCC and AC at stage IB1-IIA2.According to the prognosis The influencing factors were further analyzed.There was no statistically significant difference in tumor size,depth of invasion,and clinical stage in 3-year PFS between patients with cervical SCC and AC at stage IB1-IIA2;clinical stage,tumor size,and depth of invasion were included in the multivariate Cox regression model analysis Show:Clinical staging is an independent risk factor for the prognosis of patients with cervical SCC and AC at stage IB1-IIA2(P<0.05).Conclusion: 1.The pathological characteristics of IB1-IIA2 cervical squamous cell carcinoma and adenocarcinoma are roughly similar.Cervical squamous cell carcinoma is mainly of lettuce type,and cervical adenocarcinoma is mainly endogenous infiltrating type,which is easy to be missed.For suspicious endogenous cervical lesions,Cervical canal curettage(Endocervical Curettage,ECC)should be performed;2.According to the postoperative intermediate risk factors and appropriate postoperative adjuvant treatment,patients with stage IB1-IIA2 cervical squamous cell carcinoma and adenocarcinoma can obtain the same prognosis,and the clinical staging is the prognosis of stage IB1-IIA2 cervical squamous cell carcinoma and adenocarcinoma.Independent risk factors.更多还原