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Клинико-морфологические факторы прогноза и результаты лечения рака культи шейки матки
Клинико-морфологические факторы прогноза и результаты лечения рака культи шейки матки
Усманова Л.Ш., Кузнецов В.В., Мустафина Е.А. и др. Клинико-морфологические факторы прогноза и результаты лечения рака культи шейки матки. Современная Онкология. 2017; 19 (2): 37–41.
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Аннотация
Цель исследования: проанализировать особенности течения рака культи шейки матки (РКШМ), выявить клинические и морфологические факторы, влияющие на прогноз заболевания. Изучить результаты лечения РКШМ в зависимости от исследуемых факторов прогноза.
Материалы и методы. В работе проведен анализ результатов лечения 150 больных РКШМ 0–IIIB стадий по классификации FIGO. Пациентки находились на лечении в ФГБУ «РОНЦ им. Н.Н.Блохина» в период с 1977 по 2010 г.
Результаты. Установлено, что статистически достоверными неблагоприятными факторами прогноза РКШМ являются метастазы в регионарных лимфатических узлах, глубина инвазии опухоли в строму культи шейки матки более 1 см, стадия заболевания, смешанная форма анатомического роста опухоли и наличие раковых эмболов в лимфатических сосудах (щелях) культи шейки матки. Отмечается тенденция к ухудшению выживаемости больных с гистологически верифицированной аденокарциномой и распространением опухоли на всю культю шейки матки.
Заключение. Выявленные нами неблагоприятные факторы прогноза при РКШМ аналогичны таковым при раке шейки матки.
Ключевые слова: рак культи шейки матки, морфологические факторы прогноза, выживаемость.
Materials and methods. We have analyzed the treatment results of 150 patients with FIGO stage 0–IIIB metastatic CSC (mCSC). Patients were treated in N.N.Blokhin Russian Cancer Research Center, over the period from 1977 to 2010.
Results. We showed that statistically significant predictive factors of mCSC were regional lymph node metastases, stromal invasion greater than 1 cm in depth, stage of disease, the mixed form of tumor growth and the presence of lymph vessel tumor emboli. We also identified that the survival of the patients with histologically verified adenocarcinoma and with the spread of the tumor to the cervical stump was poor.
Conclusion. We showed that the risk factors in case of mCSC were the same as in case of cervical cancer.
Key words: cervical stump cancer, morphological predictors, survival.
Материалы и методы. В работе проведен анализ результатов лечения 150 больных РКШМ 0–IIIB стадий по классификации FIGO. Пациентки находились на лечении в ФГБУ «РОНЦ им. Н.Н.Блохина» в период с 1977 по 2010 г.
Результаты. Установлено, что статистически достоверными неблагоприятными факторами прогноза РКШМ являются метастазы в регионарных лимфатических узлах, глубина инвазии опухоли в строму культи шейки матки более 1 см, стадия заболевания, смешанная форма анатомического роста опухоли и наличие раковых эмболов в лимфатических сосудах (щелях) культи шейки матки. Отмечается тенденция к ухудшению выживаемости больных с гистологически верифицированной аденокарциномой и распространением опухоли на всю культю шейки матки.
Заключение. Выявленные нами неблагоприятные факторы прогноза при РКШМ аналогичны таковым при раке шейки матки.
Ключевые слова: рак культи шейки матки, морфологические факторы прогноза, выживаемость.
________________________________________________
Materials and methods. We have analyzed the treatment results of 150 patients with FIGO stage 0–IIIB metastatic CSC (mCSC). Patients were treated in N.N.Blokhin Russian Cancer Research Center, over the period from 1977 to 2010.
Results. We showed that statistically significant predictive factors of mCSC were regional lymph node metastases, stromal invasion greater than 1 cm in depth, stage of disease, the mixed form of tumor growth and the presence of lymph vessel tumor emboli. We also identified that the survival of the patients with histologically verified adenocarcinoma and with the spread of the tumor to the cervical stump was poor.
Conclusion. We showed that the risk factors in case of mCSC were the same as in case of cervical cancer.
Key words: cervical stump cancer, morphological predictors, survival.
Полный текст
Список литературы
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6. Ревазишвили Т.В. Профилактика и лечение рака культи шейки матки. Автореф. дис. … канд. мед. наук. Л., 1988. / Revazishvili T.V. Profilaktika i lechenie raka kul'ti sheiki matki. Avtoref. dis. … kand. med. nauk. L., 1988. [in Russian]
7. Barillot I, Horiot JC, Cuisenier J et al. Carcinoma of the cervical stump: a review of 213 cases. Eur J Cancer 1993; 29 A (9): 12–31–6.
8. Chai Y et al. Radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage IIB cervical cancer. BMC Cancer 2014; 14: 63.
9. Figat M et al. Clinical and histopathological factors in patients with cervical cancer allowing to identify candidates for less radical surgery. Ginecol Poi 2012.
10. Goodman HM, Niloff JM, Buttlar CA et al. Adenocarcinoma of the cervical stump. Oncol 1989; 35 (2): 188–92.
11. Grabiec M et al. Multiple skin metastases to vulva from carcinoma of the cervical stump Ginecol Pol 2010; 81 (2): 140–3.
12. Hale RJ, Wiicox FL, Buskley С et al. Prognostic factors in uterine cervical carcinoma; A clinicopathological analysis. Int J Gynecol Cancer 1991; 1: 1923.
13. Hellstrom AC et al. Carcinoma of the cervical stump: fifty years of the experience. Oncol Rep 2011.
14. Hilger WS et al. Removal of the retained cervical stump. Am J Obstet Gynecol 2005; 193: 2117–21.
15. Hsu СT, Cheng YS, Su SC. Prognosis of uterine cervical cancer with extensive lymph node metastasis. Am J Qbstet Gynecol 1992; 114: 954–62.
16. Inoue T, Okumura M. Prognosis significance of parametrial extension in patients with cervical carcinoma stages Ib, lla and IIIb. Cancer 1994; 54: 1714–9.
17. Inoue Т, Chihara Т, Morita K. Postoperative extended field irradiation in patients with pelvic and/or common iliac node metastasis from cervical carcinoma stages IB to IIB. Gynecol Oncol 1996; 25: 234–43.
18. Jian S. Carcinoma of the cervical stump. Clinic analysis of 10 cases. Art In Chinese 1992; 27 (4): 227–9, 251.
19. Kho RM et al. Removal of the retained cervical stump after supracervical hysterectomy. Best Pract Res Clin Obstet Gynaecol 2011; 25: 153–6.
20. Mabuchi S et al. Comporison of the prognoses of FIGO stage I to stage II adenosquamous carcinoma and adenocarcinoma of the uterine cervix treated with radical hysterectomy. Int J Gynecol Cancer 2012.
21. Michel G, Caslaigne D, Моnсе P, Duvillard P. Systematic pelvic and paraaortic lymphadenectomy in stage IB/II cervical cancer: prognostic and therapeutic value. Int J Cynecol Cancer 1997; 7: 121.
22. Nakayama K, Hirai Y, Chen JT et al. Cervical cancer after subtotal hysterectomy (so called «stamp cancer») – clinical studies on 226 cases. Nippon Sanka Fujinka Gakkai Zasshi 1989; 41 (6): 702–6.
23. Pickel H, Haas JL, Lahousen M. Prognostic factors in cervical cancer. Eur J Obstet Gynecol Reprod Biol 1997; 71: 209–13.
24. Pilleron J, Durand J, Hamelin J. Prognostic value of node metastases in cancer of the uterine cervix. Am J Obstet Gynecol 1994; 119: 458–62.
25. Pricop M, Cocos M, Aursulesei D et al. Cancer of the cervical stump. (In Romanian). Rev Med Chir Soc Nat Iasi 1999; 103 (1–2): 161–2.
26. Rechberger T et al. Carcinoma of the cervical stump-multicenter study. Ginecol Pol 2014.
27. Silva CS et al. Cervical stump cancer: a study of 14 cases. Arch Gynecol Obstet 2004; 270: 126–8.
2. Bokhman Ia.V. Rukovodstvo po onkoginekologii. M.: Meditsina, 1989. [in Russian]
3. Kiseleva E.S. Sochetannoe luchevoe lechenie bol'nykh rakom kul'ti sheiki matki. Metodicheskie rekomendatsii. M., 1990. [in Russian]
4. Laktionov K.T., Zotikov A.I., Mar'ina L.A. i dr. Ploskokletochnyi rak sheiki matki 1V stadii: kombinirovannoe lechenie. Faktory prognoza. Vestnik RONTs im. N.N.Blokhina RAMN. 2001; 4: 38–43. [in Russian]
5. Lebedev A.I. Luchevaia terapiia v kombinirovannom lechenii raka sheiki matki IB-II stadii. Avtoref. dis. … d-ra med. nauk. M., 2003. [in Russian]
6. Revazishvili T.V. Profilaktika i lechenie raka kul'ti sheiki matki. Avtoref. dis. … kand. med. nauk. L., 1988. [in Russian]
7. Barillot I, Horiot JC, Cuisenier J et al. Carcinoma of the cervical stump: a review of 213 cases. Eur J Cancer 1993; 29 A (9): 12–31–6.
8. Chai Y et al. Radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage IIB cervical cancer. BMC Cancer 2014; 14: 63.
9. Figat M et al. Clinical and histopathological factors in patients with cervical cancer allowing to identify candidates for less radical surgery. Ginecol Poi 2012.
10. Goodman HM, Niloff JM, Buttlar CA et al. Adenocarcinoma of the cervical stump. Oncol 1989; 35 (2): 188–92.
11. Grabiec M et al. Multiple skin metastases to vulva from carcinoma of the cervical stump Ginecol Pol 2010; 81 (2): 140–3.
12. Hale RJ, Wiicox FL, Buskley С et al. Prognostic factors in uterine cervical carcinoma; A clinicopathological analysis. Int J Gynecol Cancer 1991; 1: 1923.
13. Hellstrom AC et al. Carcinoma of the cervical stump: fifty years of the experience. Oncol Rep 2011.
14. Hilger WS et al. Removal of the retained cervical stump. Am J Obstet Gynecol 2005; 193: 2117–21.
15. Hsu СT, Cheng YS, Su SC. Prognosis of uterine cervical cancer with extensive lymph node metastasis. Am J Qbstet Gynecol 1992; 114: 954–62.
16. Inoue T, Okumura M. Prognosis significance of parametrial extension in patients with cervical carcinoma stages Ib, lla and IIIb. Cancer 1994; 54: 1714–9.
17. Inoue Т, Chihara Т, Morita K. Postoperative extended field irradiation in patients with pelvic and/or common iliac node metastasis from cervical carcinoma stages IB to IIB. Gynecol Oncol 1996; 25: 234–43.
18. Jian S. Carcinoma of the cervical stump. Clinic analysis of 10 cases. Art In Chinese 1992; 27 (4): 227–9, 251.
19. Kho RM et al. Removal of the retained cervical stump after supracervical hysterectomy. Best Pract Res Clin Obstet Gynaecol 2011; 25: 153–6.
20. Mabuchi S et al. Comporison of the prognoses of FIGO stage I to stage II adenosquamous carcinoma and adenocarcinoma of the uterine cervix treated with radical hysterectomy. Int J Gynecol Cancer 2012.
21. Michel G, Caslaigne D, Моnсе P, Duvillard P. Systematic pelvic and paraaortic lymphadenectomy in stage IB/II cervical cancer: prognostic and therapeutic value. Int J Cynecol Cancer 1997; 7: 121.
22. Nakayama K, Hirai Y, Chen JT et al. Cervical cancer after subtotal hysterectomy (so called «stamp cancer») – clinical studies on 226 cases. Nippon Sanka Fujinka Gakkai Zasshi 1989; 41 (6): 702–6.
23. Pickel H, Haas JL, Lahousen M. Prognostic factors in cervical cancer. Eur J Obstet Gynecol Reprod Biol 1997; 71: 209–13.
24. Pilleron J, Durand J, Hamelin J. Prognostic value of node metastases in cancer of the uterine cervix. Am J Obstet Gynecol 1994; 119: 458–62.
25. Pricop M, Cocos M, Aursulesei D et al. Cancer of the cervical stump. (In Romanian). Rev Med Chir Soc Nat Iasi 1999; 103 (1–2): 161–2.
26. Rechberger T et al. Carcinoma of the cervical stump-multicenter study. Ginecol Pol 2014.
27. Silva CS et al. Cervical stump cancer: a study of 14 cases. Arch Gynecol Obstet 2004; 270: 126–8.
2. Бохман Я.В. Руководство по онкогинекологии. М.: Медицина, 1989. / Bokhman Ia.V. Rukovodstvo po onkoginekologii. M.: Meditsina, 1989. [in Russian]
3. Киселева Е.С. Сочетанное лучевое лечение больных раком культи шейки матки. Методические рекомендации. М., 1990. / Kiseleva E.S. Sochetannoe luchevoe lechenie bol'nykh rakom kul'ti sheiki matki. Metodicheskie rekomendatsii. M., 1990. [in Russian]
4. Лактионов К.Т., Зотиков А.И., Марьина Л.А. и др. Плоскоклеточный рак шейки матки 1В стадии: комбинированное лечение. Факторы прогноза. Вестник РОНЦ им. Н.Н.Блохина РАМН. 2001; 4: 38–43. / Laktionov K.T., Zotikov A.I., Mar'ina L.A. i dr. Ploskokletochnyi rak sheiki matki 1V stadii: kombinirovannoe lechenie. Faktory prognoza. Vestnik RONTs im. N.N.Blokhina RAMN. 2001; 4: 38–43. [in Russian]
5. Лебедев А.И. Лучевая терапия в комбинированном лечении рака шейки матки IB–II стадий. Автореф. дис. … д-ра мед. наук. М., 2003. / Lebedev A.I. Luchevaia terapiia v kombinirovannom lechenii raka sheiki matki IB-II stadii. Avtoref. dis. … d-ra med. nauk. M., 2003. [in Russian]
6. Ревазишвили Т.В. Профилактика и лечение рака культи шейки матки. Автореф. дис. … канд. мед. наук. Л., 1988. / Revazishvili T.V. Profilaktika i lechenie raka kul'ti sheiki matki. Avtoref. dis. … kand. med. nauk. L., 1988. [in Russian]
7. Barillot I, Horiot JC, Cuisenier J et al. Carcinoma of the cervical stump: a review of 213 cases. Eur J Cancer 1993; 29 A (9): 12–31–6.
8. Chai Y et al. Radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage IIB cervical cancer. BMC Cancer 2014; 14: 63.
9. Figat M et al. Clinical and histopathological factors in patients with cervical cancer allowing to identify candidates for less radical surgery. Ginecol Poi 2012.
10. Goodman HM, Niloff JM, Buttlar CA et al. Adenocarcinoma of the cervical stump. Oncol 1989; 35 (2): 188–92.
11. Grabiec M et al. Multiple skin metastases to vulva from carcinoma of the cervical stump Ginecol Pol 2010; 81 (2): 140–3.
12. Hale RJ, Wiicox FL, Buskley С et al. Prognostic factors in uterine cervical carcinoma; A clinicopathological analysis. Int J Gynecol Cancer 1991; 1: 1923.
13. Hellstrom AC et al. Carcinoma of the cervical stump: fifty years of the experience. Oncol Rep 2011.
14. Hilger WS et al. Removal of the retained cervical stump. Am J Obstet Gynecol 2005; 193: 2117–21.
15. Hsu СT, Cheng YS, Su SC. Prognosis of uterine cervical cancer with extensive lymph node metastasis. Am J Qbstet Gynecol 1992; 114: 954–62.
16. Inoue T, Okumura M. Prognosis significance of parametrial extension in patients with cervical carcinoma stages Ib, lla and IIIb. Cancer 1994; 54: 1714–9.
17. Inoue Т, Chihara Т, Morita K. Postoperative extended field irradiation in patients with pelvic and/or common iliac node metastasis from cervical carcinoma stages IB to IIB. Gynecol Oncol 1996; 25: 234–43.
18. Jian S. Carcinoma of the cervical stump. Clinic analysis of 10 cases. Art In Chinese 1992; 27 (4): 227–9, 251.
19. Kho RM et al. Removal of the retained cervical stump after supracervical hysterectomy. Best Pract Res Clin Obstet Gynaecol 2011; 25: 153–6.
20. Mabuchi S et al. Comporison of the prognoses of FIGO stage I to stage II adenosquamous carcinoma and adenocarcinoma of the uterine cervix treated with radical hysterectomy. Int J Gynecol Cancer 2012.
21. Michel G, Caslaigne D, Моnсе P, Duvillard P. Systematic pelvic and paraaortic lymphadenectomy in stage IB/II cervical cancer: prognostic and therapeutic value. Int J Cynecol Cancer 1997; 7: 121.
22. Nakayama K, Hirai Y, Chen JT et al. Cervical cancer after subtotal hysterectomy (so called «stamp cancer») – clinical studies on 226 cases. Nippon Sanka Fujinka Gakkai Zasshi 1989; 41 (6): 702–6.
23. Pickel H, Haas JL, Lahousen M. Prognostic factors in cervical cancer. Eur J Obstet Gynecol Reprod Biol 1997; 71: 209–13.
24. Pilleron J, Durand J, Hamelin J. Prognostic value of node metastases in cancer of the uterine cervix. Am J Obstet Gynecol 1994; 119: 458–62.
25. Pricop M, Cocos M, Aursulesei D et al. Cancer of the cervical stump. (In Romanian). Rev Med Chir Soc Nat Iasi 1999; 103 (1–2): 161–2.
26. Rechberger T et al. Carcinoma of the cervical stump-multicenter study. Ginecol Pol 2014.
27. Silva CS et al. Cervical stump cancer: a study of 14 cases. Arch Gynecol Obstet 2004; 270: 126–8.
________________________________________________
2. Bokhman Ia.V. Rukovodstvo po onkoginekologii. M.: Meditsina, 1989. [in Russian]
3. Kiseleva E.S. Sochetannoe luchevoe lechenie bol'nykh rakom kul'ti sheiki matki. Metodicheskie rekomendatsii. M., 1990. [in Russian]
4. Laktionov K.T., Zotikov A.I., Mar'ina L.A. i dr. Ploskokletochnyi rak sheiki matki 1V stadii: kombinirovannoe lechenie. Faktory prognoza. Vestnik RONTs im. N.N.Blokhina RAMN. 2001; 4: 38–43. [in Russian]
5. Lebedev A.I. Luchevaia terapiia v kombinirovannom lechenii raka sheiki matki IB-II stadii. Avtoref. dis. … d-ra med. nauk. M., 2003. [in Russian]
6. Revazishvili T.V. Profilaktika i lechenie raka kul'ti sheiki matki. Avtoref. dis. … kand. med. nauk. L., 1988. [in Russian]
7. Barillot I, Horiot JC, Cuisenier J et al. Carcinoma of the cervical stump: a review of 213 cases. Eur J Cancer 1993; 29 A (9): 12–31–6.
8. Chai Y et al. Radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage IIB cervical cancer. BMC Cancer 2014; 14: 63.
9. Figat M et al. Clinical and histopathological factors in patients with cervical cancer allowing to identify candidates for less radical surgery. Ginecol Poi 2012.
10. Goodman HM, Niloff JM, Buttlar CA et al. Adenocarcinoma of the cervical stump. Oncol 1989; 35 (2): 188–92.
11. Grabiec M et al. Multiple skin metastases to vulva from carcinoma of the cervical stump Ginecol Pol 2010; 81 (2): 140–3.
12. Hale RJ, Wiicox FL, Buskley С et al. Prognostic factors in uterine cervical carcinoma; A clinicopathological analysis. Int J Gynecol Cancer 1991; 1: 1923.
13. Hellstrom AC et al. Carcinoma of the cervical stump: fifty years of the experience. Oncol Rep 2011.
14. Hilger WS et al. Removal of the retained cervical stump. Am J Obstet Gynecol 2005; 193: 2117–21.
15. Hsu СT, Cheng YS, Su SC. Prognosis of uterine cervical cancer with extensive lymph node metastasis. Am J Qbstet Gynecol 1992; 114: 954–62.
16. Inoue T, Okumura M. Prognosis significance of parametrial extension in patients with cervical carcinoma stages Ib, lla and IIIb. Cancer 1994; 54: 1714–9.
17. Inoue Т, Chihara Т, Morita K. Postoperative extended field irradiation in patients with pelvic and/or common iliac node metastasis from cervical carcinoma stages IB to IIB. Gynecol Oncol 1996; 25: 234–43.
18. Jian S. Carcinoma of the cervical stump. Clinic analysis of 10 cases. Art In Chinese 1992; 27 (4): 227–9, 251.
19. Kho RM et al. Removal of the retained cervical stump after supracervical hysterectomy. Best Pract Res Clin Obstet Gynaecol 2011; 25: 153–6.
20. Mabuchi S et al. Comporison of the prognoses of FIGO stage I to stage II adenosquamous carcinoma and adenocarcinoma of the uterine cervix treated with radical hysterectomy. Int J Gynecol Cancer 2012.
21. Michel G, Caslaigne D, Моnсе P, Duvillard P. Systematic pelvic and paraaortic lymphadenectomy in stage IB/II cervical cancer: prognostic and therapeutic value. Int J Cynecol Cancer 1997; 7: 121.
22. Nakayama K, Hirai Y, Chen JT et al. Cervical cancer after subtotal hysterectomy (so called «stamp cancer») – clinical studies on 226 cases. Nippon Sanka Fujinka Gakkai Zasshi 1989; 41 (6): 702–6.
23. Pickel H, Haas JL, Lahousen M. Prognostic factors in cervical cancer. Eur J Obstet Gynecol Reprod Biol 1997; 71: 209–13.
24. Pilleron J, Durand J, Hamelin J. Prognostic value of node metastases in cancer of the uterine cervix. Am J Obstet Gynecol 1994; 119: 458–62.
25. Pricop M, Cocos M, Aursulesei D et al. Cancer of the cervical stump. (In Romanian). Rev Med Chir Soc Nat Iasi 1999; 103 (1–2): 161–2.
26. Rechberger T et al. Carcinoma of the cervical stump-multicenter study. Ginecol Pol 2014.
27. Silva CS et al. Cervical stump cancer: a study of 14 cases. Arch Gynecol Obstet 2004; 270: 126–8.
Авторы
Л.Ш.Усманова1, В.В.Кузнецов1, Е.А.Мустафина*1, В.В.Баринов1, И.И.Бокин2, Р.И.Князев2, М.Д.Ахмедова1
1 ФГБУ «Российский онкологический научный центр им. Н.Н.Блохина» Минздрава России. 115478, Россия, Москва, Каширское ш., д. 23;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 123995, Россия, Москва, ул. Баррикадная, д. 2/1
*ekaterina.mustafina.78@mail.ru
1 N.N.Blokhin Russian Cancer Research Center of the Ministry of Health of the Russian Federation. 115478, Russian Federation, Moscow, Kashirskoe sh., d. 23;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 123995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*ekaterina.mustafina.78@mail.ru
1 ФГБУ «Российский онкологический научный центр им. Н.Н.Блохина» Минздрава России. 115478, Россия, Москва, Каширское ш., д. 23;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 123995, Россия, Москва, ул. Баррикадная, д. 2/1
*ekaterina.mustafina.78@mail.ru
________________________________________________
1 N.N.Blokhin Russian Cancer Research Center of the Ministry of Health of the Russian Federation. 115478, Russian Federation, Moscow, Kashirskoe sh., d. 23;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 123995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*ekaterina.mustafina.78@mail.ru
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