HPV感染与特殊类型宫颈腺癌预后相关性分析

Correlation between HPV infection and prognosis of endocervical adenocarcinoma

摘要:

目的： 本研究将宫颈特殊类型腺癌分为人乳头瘤状病毒（human papillomavirus，HPV）感染相关型和非HPV感染相关型，探讨不同分型与预后的关系。方法： 收集美国SEER数据库共468例宫颈特殊类型腺癌患者的临床资料进行回顾性分析，将其分为HPV感染相关型（HPV-associated adenocarcinoma，HPVA）组和非HPV感染相关型（non-HPV-associated adenocarcinoma，NHPVA）组，采用卡方检验、Fisher检验、K-M法、log-rank检验、Cox回归模型进行统计学分析。结果： 组间比较结果显示2组患者在分期、肿瘤分化程度方面有明显统计学差异。NHPVA组比HPVA组期别更晚（P=0.001），肿瘤分化更差（P<0.05）。肿瘤相关死亡率在NHPVA组（70/205，34.1%）明显高于HPVA组（53/263，20.2%），NHPVA组总体预后差于HPVA组（P=0.001）。5个病理亚型间预后差异有明显统计学意义（P=0.002），浆液性癌预后最差。结论： 基于是否感染HPV对宫颈特殊类型腺癌进行分类能预测患者预后，从而采取相应治疗措施，将对临床工作产生一定指导意义。

Abstract:

Objective: To analyze the prognostic relationship between Human papillomavirus (HPV) -infection and endocervical adenocarcinoma (ECA) of the uterine cervix, so as to provide a reference for clinical work. Methods: Clinical data of 468 ECA patients screened from SEER Database were divided into HPVA (HPV-associated adenocarcinoma) and NHPVA (non-HPV-associated Adenocarcinoma) group, followed by a retrospective analysis, which were statistically analyzed using Chi-square test, Fisher test, K-M method, log-rank test and Cox regression. Results: There were significant differences in stage and tumor differentiation grade between the two groups. Compared with HPVA group, the stage of NHPVA group was later (P=0.001), and the tumor differentiation was worse (P<0.05). The NHPVA group had a significantly higher cancer-related mortality (70/205, 34.1%) than HPVA group (53/263, 20.2%). The prognosis was significantly worse in NHPVA group than HPVA group (P=0.001). The cancer-related mortality was significantly different (P=0.002) within the 5 sub-groups of mucinous, gastic type, villoglandular, clear cell, and serous carcinoma, while the serous type had the worst prognosis. Conclusion: It is important to classify the ECA into HPVA and NHPVA for clinical work in the future.