目的:探讨宫颈微小偏离腺癌(MDA)的临床病理特征及预后因素。一种临床上罕见但高度侵袭性的疾病。
方法:这是一个回顾性研究,观察,2010年11月至2021年11月在复旦大学妇产科医院进行的43例经病理证实的MDA患者的真实世界研究。收集和审查基线临床病理数据。通过单变量和多变量Cox比例风险分析研究了无进展生存期(PFS)和总生存期(OS)的预后因素。
结果:主诉包括不规则的阴道分泌物和/或出血(74.4%)。术前诊断困难,检出率低(36.8%),所有病例均显示内生病变,88.4%有深层基质侵入,具有生物学攻击性特征。卵巢转移率高(16.3%,7/43).肿瘤的中位最大直径(MDOT)为4.3cm(范围,0.5-8.0厘米)。MDOT与OS显著相关(P=0.009),使用X-tile软件定义大体积MDA的最佳临界值为5.5cm(P<0.0001,χ=21.161)。独立的预后因素包括MDOT(HR=10.095,P=0.001)和卵巢转移(HR=5.888,P=0.008)的OS和MDOT(HR=3.944,P=0.028)。卵巢转移(HR=9.285,P=0.001),深度入渗(HR=3.627,P=0.048)为PFS。
结论:MDA可能是子宫内膜病变发展和卵巢转移。庞大的肿瘤和卵巢转移表明预后较差。鉴于MDA的特殊生物学特性,使用5.5厘米作为定义庞大肿瘤的阈值比使用4厘米更合适。应优先考虑卵巢切除以改善预后。
OBJECTIVE: To elucidate the clinicopathological features and prognostic factors of minimal deviation adenocarcinoma (MDA) of the uterine cervix, a clinically rare but highly invasive disease.
METHODS: This was a retrospective, observational, real-world study of 43 patients with pathologically confirmed MDA at the Obstetrics and Gynaecology Hospital of Fudan University between November 2010 and November 2021. Baseline clinicopathological data were collected and reviewed. Prognostic factors for progression-free survival (PFS) and overall survival (OS) were investigated by univariate and multivariate Cox proportional hazards analyses.
RESULTS: Chief complaints included irregular vaginal discharge and/or bleeding (74.4%). Preoperative diagnosis was difficult, the detection rate was low (36.8%), all cases showed endophytic lesions, and 88.4% had deep stromal invasion, with biologically aggressive characteristics. The ovarian metastasis rate was high (16.3%, 7/43). The median maximum diameter of the tumour (MDOT) was 4.3 cm (range, 0.5-8.0 cm). MDOT was significantly associated with OS (P = 0.009), and the optimal cut-off value to define bulky MDA was 5.5 cm (P < 0.0001, χ= 21.161) using X-tile software. Independent prognostic factors included MDOT (HR = 10.095, P = 0.001) and ovarian metastasis (HR = 5.888, P = 0.008) for OS and MDOT (HR = 3.944, P = 0.028), ovarian metastasis (HR = 9.285, P = 0.001), and deep infiltration (HR = 3.627, P = 0.048) for PFS.
CONCLUSIONS: Endophytic lesion development and ovarian metastasis are likely in MDA. A bulky tumour and ovarian metastasis indicate a worse prognosis. Given the special biological features of MDA, it is more appropriate to use 5.5 cm as the threshold for defining a bulky tumour than it is to use 4 cm. Ovary removal should be given higher priority to improve prognosis.