[1]邢艳 邹运 吴玉梅**.子宫颈胃型腺癌18例临床分析[J].中国微创外科杂志,2021,01(11):1001-1005.
　Xing Yan,Zou Yun,Wu Yumei..Clinical Analysis of 18 Cases of Gastrictype Endocervical Adenocarcinoma[J].Chinese Journal of Minimally Invasive Surgery,2021,01(11):1001-1005.
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子宫颈胃型腺癌18例临床分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年11期
页码:
1001-1005
栏目:
临床研究
出版日期:
2021-11-25

文章信息/Info

Title:
Clinical Analysis of 18 Cases of Gastrictype Endocervical Adenocarcinoma
作者:
邢艳 邹运 吴玉梅**
（首都医科大学附属北京妇产医院北京妇幼保健院妇瘤科，北京100006）
Author(s):
Xing Yan;  Zou Yun;  Wu Yumei.
Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
关键词:
宫颈癌; 胃型腺癌; 诊断; 治疗; 预后
Keywords:
Cervical cancer; Gastrictype adenocarcinoma; Diagnosis; Treatment; Prognosis
文献标志码:
A
摘要:
目的探讨子宫颈胃型腺癌（gastrictype endocervical adenocarcinoma，GEAC）的临床病理特征、治疗策略及预后。方法回顾性分析2016年5月~2021年4月18例GEAC的临床、病理、治疗及生存资料。平均发病年龄51.5岁（35~65岁）。首发症状为阴道排液8例，接触性出血或异常阴道出血5例，腹痛1例，无症状4例。11例行TCT检查，提示腺癌1例，非典型腺细胞（AGC）4例，低度鳞状上皮内病变（LSIL）1例，非典型鳞状细胞-不能明确意义（ASCUS）3例，正常2例。10例行HPV检测，均为阴性。17例行肿瘤标记物检查，CA199升高10例（其中6例CA199＞10倍正常值），CA125升高5例，癌胚抗原（CEA）升高3例，鳞状细胞癌抗原（SCCA）升高1例。结果Ⅰ期3例，Ⅱ期4例，Ⅲ期8例，Ⅳ期3例。行根治性手术10例（其中4例联合新辅助化疗），筋膜外全子宫切除1例，全子宫+双附件+大网膜切除1例，分期手术1例，根治性同步放化疗5例。12例术后全身化疗和（或）同步放化疗。13例手术患者的术后病理，卵巢转移6例，盆腔淋巴结转移6例，腹主动脉旁淋巴结转移1例，大网膜转移2例，腹膜转移1例。在初始治疗中，8例肿瘤未控，其中1例在治疗结束时发现腹壁转移，定义为肿瘤未控，化疗加用贝伐珠单抗，疾病完全缓解。随访至2021年7月，1例失访，5例肿瘤相关死亡。结论GEAC恶性程度高，预后差，大多患者诊断即为晚期，常合并卵巢、盆腔淋巴结及腹腔转移，CA199可能是GEAC的肿瘤标记物，传统治疗效果欠佳。
Abstract:
ObjectiveTo investigate the clinicopathological features, treatment strategies and prognosis of gastrictype endocervical adenocarcinoma (GEAC).MethodsThe clinical, pathological, therapeutic and survival data of 18 patients with GEAC from May 2016 to April 2021 were retrospectively analyzed. The mean age of onset was 51.5 years old (range, 35-65 years old). The first symptoms were vaginal fluid in 8 cases, contact bleeding or abnormal vaginal bleeding in 5 cases, abdominal pain in 1 case and asymptomatic in 4 cases. There were 11 patients who underwent TCT examinations, including adenocarcinoma in 1 case, atypical adenocarcinoma (AGC) in 4 cases, low grade squamous intraepithelial lesion (LSIL) in 1 case, atypical squamous cell of undetermined significance (ASCUS) in 3 cases, and 2 normal cases. The HPV was detected in 10 cases, all of which were negative. Tumor markers were examined in 17 cases, including CA199 increased in 10 cases (CA199 > 10 times of the normal value in 6 cases), CA125 increased in 5 cases, carcinoembryonic antigen (CEA) increased in 3 cases and squamous cell carcinoma antigen (SCCA) increased in 1 case.ResultsThere were 3 cases of stage Ⅰ, 4 cases of stage Ⅱ, 8 cases of stage Ⅲ and 3 cases of stage Ⅳ. Radical surgery was performed in 10 cases (4 cases combined with neoadjuvant chemotherapy), total extrafascial hysterectomy in 1 case, hysterectomy+bilateral salpinx oophorectomy+omentum resection in 1 case, staging surgery in 1 case, and radical concurrent chemoradiotherapy in 5 cases. Postoperative systemic chemotherapy and/or concurrent chemoradiotherapy were performed in 12 patients. Postoperative pathology of 13 patients included ovarian metastasis in 6 cases, pelvic lymph node metastasis in 6 cases, paraaortic lymph node metastasis in 1 case, omentum metastasis in 2 cases, peritoneal metastasis in 1 case. In the initial treatment, the tumor was uncontrolled in 8 cases, including 1 case with abdominal wall metastasis at the end of treatment, which was defined as the tumor was uncontrolled,followed by chemotherapy combined with bevacizumab therapy, and the disease was complete response. Up to July 2021, 1 patient was lost to followup and 5 patients had tumorrelated death.ConclusionsGEAC has a high degree of malignancy and poor prognosis. Most patients are diagnosed as advanced stage, often complicated with ovarian, pelvic lymph node and abdominal metastasis. CA199 may be a tumor marker of GEAC, and the efficacy of traditional treatment is not good.

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备注/Memo

备注/Memo:
基金项目：“扬帆”计划重点医学专业（ZYLX201705）；首都临床诊疗技术研究及示范应用（Z191100006619035）**通讯作者，Email：wym597118@ccmu.edu.cn
更新日期/Last Update: 2022-02-10