摘要
目的:探讨子宫颈透明细胞癌(CCAC)的临床特征、病理特点、治疗及预后。方法:回顾性分析1999年1月1日至2024年6月20日于江西省妇幼保健院诊治的72例CCAC的临床资料。结果:发病中位年龄50岁。早期(ⅠB1、ⅠB2、ⅡA1期)19例,中晚期(ⅠB3期、ⅡA2~ⅣB期)51例,未分期2例。38例患者中癌抗原125(CA125)升高19例(50.0%),20例患者中薄层液基细胞学检查(TCT)异常14例(70.0%),45例中人乳头瘤病毒(HPV)检测阳性20例(44.5%)。肝细胞核因子1-β(HNF-1β)阳性95.2%,配对盒基因8抗原(PAX-8)阳性91.3%。32例以手术治疗为主的患者中,术后病理盆腔淋巴结转移5例(15.6%),脉管间质浸润9例(28.1%),均未发现卵巢转移。患者平均随访45月,5年总生存率(OS)为51.4%,早期和中晚期OS分别为57.9%、47.1%。32例以手术治疗为主的患者5年OS为52.8%,其中9例于术前行新辅助化疗,5年OS为33.3%;38例以根治性放化疗为主的患者5年OS为47.1%,其中5例接受中心病灶切除术,5年OS达80.0%。结论:CCAC多见于中老年女性,中晚期患者居多,HPV、TCT及CA_(125)检测对CCAC具有一定的诊断价值。早期CCAC患者接受手术治疗后,生存率相对较好,但仍需个体化评估。术前行新辅助化疗对改善患者预后的作用可能有限。对于部分放化疗结束后的患者,中心病灶切除或许有助于改善预后,但需进一步研究验证。
Objective:To investigate the clinical characteristics,pathological features,treatment,and prognosis of clear cell adenocarcinoma of cervix(CCAC).Methods:Clinical data of 72 CCAC patients treated at Jiangxi Maternal and Child Health Hospital from January 1,1999,to June 20,2024,were retrospectively analyzed.Results:The median age at diagnosis was 50 years.Of the patients,19 were classified as early-stage(IB1,IB2,IIA1),51 as mid-advanced stage(IB3,IIA2-IVB),and 2 were unstaged.Among 38 patients,elevated cancer Antigen 125(CA125)levels were observed in 19(50.0%).Abnormal thin-layer liquid-based cytology(TCT)results were detected in 14 of 20 patients(70.0%),and human papillomavirus(HPV)positivity was identified in 20 of 45 patients(44.5%).Immunohistochemical analysis revealed hepatocyte nuclear factor-1β(HNF-1β)positivity in 95.2%and paired box gene 8(PAX-8)positivity in 91.3%.Among 32 patients undergoing primary surgery,postoperative pathology confirmed pelvic lymph node metastasis in 5(15.6%),lymphovascular and stromal invasion in 9(28.1%),with no ovarian metastasis observed.With a median follow-up of 45 months,the 5-year overall survival(OS)rate was 51.4%,with early-stage and mid-advanced stage OS rates of 57.9%and 47.1%,respectively.The 5-year OS rate for surgically managed patients was 52.8%,while preoperative neoadjuvant chemotherapy(9 cases)yielded a 5-year OS of 33.3%.Among 38 patients treated primarily with radiotherapy and/or chemotherapy,the 5-year OS was 47.1%,with 5 patients undergoing central lesion resection achieving an 80.0%5-year OS.Conclusions:CCAC predominantly affects middle-aged and elderly women,with advanced-stage presentations being common.HPV,TCT,and CA_(125) testing hold diagnostic value for CCAC.Patients with early-stage CCAC undergoing surgical treatment demonstrated a relatively favorable survival rate;however,individualized assessment remains essential.Neoadjuvant chemotherapy administered prior to surgery may have limited efficacy in improving patient prognosis.For selected patients completing radiotherapy and/or chemotherapy,central lesion resection may potentially improve prognosis,although further well-designed studies are required to validate this finding.
作者
王艳
李隆玉
敖梅红
程晓晓
胡双
WANG Yan;LI Longyu;AO Meihong(Department of Gynecologic Oncology,Jiangxi Maternal and Child Health Hospital,Nanchang Jiangxi 330027,China)
出处
《实用妇产科杂志》
北大核心
2025年第11期955-960,共6页
Journal of Practical Obstetrics and Gynecology
关键词
子宫颈透明细胞癌
临床特征
新辅助化疗
中心病灶切除
预后
Clear cell adenocarcinoma of cervix
Clinical features
Neoadjuvant chemotherapy
Central lesion resection
Prognosis
