目的:胃型宫颈腺癌(GEA)是一种罕见的宫颈癌,与人乳头瘤病毒(HPV)感染无关。我们总结了GEA在大型癌症中心的经验。
方法:从临床图表中回顾性获得2002年6月1日至2019年7月1日期间诊断为GEA的所有患者的临床和人口统计学信息。进行Kaplan-Meier生存分析以描述无进展生存(PFS)和总生存(OS)。来自患者子集的肿瘤进行了下一代测序(NGS)分析。
结果:共确定了70名GEA患者,包括在我们机构接受初始治疗的43人:其中4人(9%)仅接受了手术,15人(35%)接受手术后接受辅助治疗,10例(23%)接受确定性同步放化疗(CCRT)治疗,7(16%)单独化疗,3例(7%)新辅助CCRT和子宫切除术伴或不伴化疗。三分之一(n=14)的患者经历了疾病进展,其中86%(n=12)有CCRT。I期GEA患者的中位PFS和OS分别为107个月(95%CI14.8-199.2个月)和111个月(95%CI17-205.1个月)。与II-IV期患者的17个月(95%CI5.6-28.4个月)和33个月(95%CI28.2-37.8个月)相比,分别。在NGS上,4例患者(14%)有ERBB2改变,包括2例接受曲妥珠单抗治疗的患者.
结论:GEA是一种侵袭性宫颈癌,在II期或更晚期诊断时PFS和OS较差。需要进一步的研究来确定这种罕见亚型的最佳管理方法。
OBJECTIVE: Gastric-type endocervical adenocarcinoma (GEA) is a rare form of cervical cancer not associated with human papilloma virus (HPV) infection. We summarize our experience with GEA at a large cancer center.
METHODS: Clinical and demographic information on all patients diagnosed with GEA between June 1, 2002 and July 1, 2019 was obtained retrospectively from clinical charts. Kaplan-Meier survival analysis was performed to describe progression-free survival (PFS) and overall survival (OS). Tumors from a subset of patients underwent next generation sequencing (NGS) analysis.
RESULTS: A total of 70 women with GEA were identified, including 43 who received initial treatment at our institution: of these 4 (9%) underwent surgery alone, 15 (35%) underwent surgery followed by adjuvant therapy, 10 (23%) were treated with definitive concurrent chemoradiation (CCRT), 7 (16%) with chemotherapy alone, and 3 (7%) with neoadjuvant CCRT and hysterectomy with or without chemotherapy. One-third (n = 14) of patients experienced disease progression, of whom 86% (n = 12) had prior CCRT. The median PFS and OS for patients with stage I GEA were 107 months (95% CI 14.8-199.2 months) and 111 months (95% CI 17-205.1 months) respectively, compared to 17 months (95% CI 5.6-28.4 months) and 33 months (95% CI 28.2-37.8 months) for patients with stages II-IV, respectively. On NGS, 4 patients (14%) had ERBB2 alterations, including 2 patients who received trastuzumab.
CONCLUSIONS: GEA is an aggressive form of cervical cancer with poor PFS and OS when diagnosed at stage II or later. Further investigation is needed to identify the optimal management approach for this rare subtype.