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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2026, Vol. 22 ›› Issue (02) : 128 -139. doi: 10.3877/cma.j.issn.1673-5250.2026.02.005

论著

特殊类型宫颈腺癌患者的多中心回顾性临床分析
刘传于1, 胡建国1, 王荔2, 许鑫玥3, 刁帅4, 杨茜5, 胡丽娜1,†()   
  1. 1重庆医科大学附属第二医院妇产科，重庆　400000
    2电子科技大学医学院附属成都市妇女儿童中心医院生殖健康与不孕症科，成都　610073
    3成都市第三人民医院，成都　610031
    4重庆医科大学附属妇女儿童医院妇产科，重庆　400000
    5川北医学院附属遂宁市中心医院妇产科，遂宁　629000
  • 收稿日期:2025-11-07 修回日期:2026-01-07 出版日期:2026-04-01
  • 通信作者: 胡丽娜

Multicenter retrospective clinical analysis of special types of cervical adenocarcinoma

Chuanyu Liu1, Jianguo Hu1, Li Wang2, Xinyue Xu3, Shuai Diao4, Qian Yang5, Lina Hu1,†()   

  1. 1Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
    2Chengdu Women and Children′s Central Hospital, University of Electronic Science and Technology of China, Chengdu 610073, Sichuan Province, China
    3the Third People′s Hospital of Chengdu, Chengdu 610031, Sichuan Province, China
    4Department of Obstetrics and Gynecology, Children′s Hospital of Chongqing Medical University, Chongqing 400000, China
    5Department of Obstetrics and Gynecology, Suining Central Hospital Affiliated to North Sichuan Medical College, Suining 629000, Sichuan Province, China
  • Received:2025-11-07 Revised:2026-01-07 Published:2026-04-01
  • Corresponding author: Lina Hu
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引用本文：

刘传于, 胡建国, 王荔, 许鑫玥, 刁帅, 杨茜, 胡丽娜. 特殊类型宫颈腺癌患者的多中心回顾性临床分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2026, 22(02): 128-139.

Chuanyu Liu, Jianguo Hu, Li Wang, Xinyue Xu, Shuai Diao, Qian Yang, Lina Hu. Multicenter retrospective clinical analysis of special types of cervical adenocarcinoma[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2026, 22(02): 128-139.

目的

探讨特殊类型宫颈腺癌患者的临床与病理学特征、免疫表型、治疗反应及预后影响因素。

方法

选择2019—2024年于重庆医科大学附属第二医院、重庆医科大学附属第一医院、重庆市妇幼保健院、四川省妇幼保健院及川北医学院附属遂宁市中心医院5家医院收治的79例特殊类型宫颈腺癌患者为研究对象。采用回顾性分析方法，收集所有患者的一般临床资料、临床表现、辅助检查结果、治疗策略及预后情况。基于多中心临床数据，采用单因素与多因素Cox比例风险回归分析方法，分析特殊类型宫颈腺癌患者预后的独立影响因素。本研究遵循的程序符合重庆医科大学附属第二医院伦理委员会制定的标准，并获得该伦理委员会批准[伦理审批号：2025年伦审(350)号]。与所有患者签订临床研究知情同意书。

结果

①临床特征：本研究79例患者的中位发病年龄为53岁(31~78岁)；首发症状以阴道异常出血(43例，54.4%)和阴道分泌物异常增多(17例，21.5%)最为常见。②病理学特征：本研究79例患者涉及12种病理学亚型，其中胃型腺癌(GAS)(18例，22.8%)与浸润性复层产黏液型腺癌(iSMC)(11例，13.9%)及腺鳞癌(11例，13.9%)较为多见。根据国际妇产科联盟(FIGO)(2018版)宫颈癌分期标准，Ⅰ期患者为51例(64.6%)，Ⅱ期为15例(19.0%)，Ⅲ期为12例(15.2%)，Ⅳ期仅为1例(1.3%)。术前检查结果显示，其中人乳头瘤病毒(HPV)感染率为68.8%(44/64)，液基薄层细胞学检查(TCT)结果异常占62.3%(33/53)，肿瘤标志物异常占46.4%(26/56)。③免疫表型：79例患者的免疫表型较为复杂，各类亚型间存在显著差异，如17例GAS患者中，以黏蛋白6(MUC6)(11例)、黏蛋白5AC(MUC5AC)(9例)呈阳性为主，P16呈阳性仅为5例，雌激素受体(ER)/孕激素受体(PR)呈阴性为15例；11例iSMC患者中，则呈现P16弥漫强阳性(11例)及癌胚抗原(CEA)高表达(9例)；11例腺鳞癌患者中，10例进行免疫组化的结果显示，P16、CEA呈阳性均为8例。④治疗反应：76例(96.2%)接受根治性手术治疗患者中，21例仅进行手术治疗，其余患者仅联合术前诱导化疗(2例)，术后辅助化疗(18例)或术后辅助放、化疗(35例)；8例高危患者术后同时接受免疫治疗，6例接受靶向药物治疗；3例患者因FIGO临床分期较晚，或个人意愿未进行手术，仅接受同步放、化疗或单纯化疗。随访结果显示，至末次随访时，12例(15.2%)复发，4例(5.1%)死亡，1年无病生存(DFS)率为88.2%。⑤预后影响因素：单因素Cox比例风险回归分析结果显示，FIGO临床分期、病理学亚型、临床首发症状及治疗方式，可能为特殊类型宫颈腺癌患者死亡风险的影响因素(P<0.05)。将这4项因素及患者发病年龄纳入多因素Cox比例风险回归分析的结果显示，FIGO临床分期为Ⅲ~Ⅳ期(HR＝25.965，95%CI：2.260~298.000，P＝0.009)，病理学亚型为混合性腺癌-神经内分泌癌(MiNEN)(HR＝2 033.598，95%CI：22.100~1.870×105，P＝0.001)与子宫内膜样腺癌(EAC)(HR＝493.705，95%CI：17.300~1.410×104，P<0.001)及印戒细胞腺癌(SRCC)(HR＝373.255，95%CI：2.010~6.930×104，P＝0.026)，均为导致本研究特殊类型宫颈腺癌患者死亡的独立危险因素。

结论

特殊类型宫颈腺癌具有高度异质性，其发病率较低，临床表现缺乏特异性，常导致诊断困难。本研究通过多中心数据分析证实，病理学亚型、FIGO临床分期可作为评估此类患者预后的重要指标。

关键词: 宫颈肿瘤, 宫颈腺癌, 特殊亚型, 临床特征, 肿瘤分期, 治疗, 预后, 女(雌)性
Objective

To explore the clinical and pathological characteristics, immunophenotypes, treatment responses and prognostic factors in patients with specific types of cervical adenocarcinoma.

Methods

A total of 79 patients with special type of cervical adenocarcinoma who were treated at the Second Affiliated Hospital of Chongqing Medical University, the First Affiliated Hospital of Chongqing Medical University, Chongqing Maternal and Child Health Hospital, Sichuan Provincial Maternity and Child Health Care Hospital, and Suining Central Hospital in Sichuan Province from 2019 to 2024 were selected as research subjects. General clinical data, clinical manifestations, auxiliary examination results, treatment strategies, and prognostic outcomes of all patients were collected by retrospective study method. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent prognostic factors for patients with special type of cervical adenocarcinoma based on multicenter clinical data. This study adhered to procedures established by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University and received its approval (Ethics Approval No. 2025-350). Informed consent forms for clinical research were obtained from all patients.

Results

①Clinical characteristics: the median age at onset among the 79 patients in this study was 53 years (range: 31-78 years). The most common initial symptoms were abnormal vaginal bleeding (43 cases, 54.4%) and increased vaginal discharge (17 cases, 21.5%). ②Pathological characteristics: 12 pathological subtypes were identified, with gastric-type adenocarcinoma (GAS) (18 cases, 22.8%) and invasive stratified mucin-producing carcinoma (iSMC) (11 cases, 13.9%) and adenosquamous carcinoma (11 cases, 13.9%) being relatively prevalent. According to the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging criteria for cervical cancer, 51 cases (64.6%) were stage Ⅰ, 15 cases (19.0%) were stage Ⅱ, 12 cases (15.2%) were stage Ⅲ, and only 1 case (1.3%) was stage Ⅳ. Preoperative examination results showed a human papillomavirus (HPV) infection rate of 68.8% (44/64), abnormal ThinPrep liquid-based cytology test (TCT) results in 62.3% (33/53) cases, and abnormal tumor marker levels in 46.4% (26/56) patients. ③Immunophenotypes: pathological examination results indicated that the immunophenotypes of the 79 patients were quite complex, with significant differences among various subtypes. For example, among the 17 GAS patients, the majority were positive for mucin 6 (MUC6) (11 cases) and mucin 5AC (MUC5AC) (9 cases), while only 5 cases were positive for P16, and 15 cases were negative for estrogen receptor (ER)/progesterone receptor (PR). Among the 11 iSMC patients, there was diffuse strong positivity for P16 (11 cases) and high expression of carcinoembryonic antigen (CEA) (9 cases). Among the 11 adenosquamous carcinoma patients, immunohistochemical results in 10 cases showed that P16 (8 cases) and CEA (8 cases) were generally positive. ④Treatment responses: 76 patients (96.2%) underwent radical surgery, of which 21 underwent surgery alone, and the remaining patients underwent combined preoperative induction chemotherapy alone (2 cases), postoperative adjuvant chemotherapy (18 cases), or postoperative adjuvant chemoradiotherapy (35 cases); 8 high-risk patients received immunotherapy at the same time after surgery, and 6 patients received targeted therapy; 3 patients did not undergo surgery due to late FIGO stage or personal wishes and received concurrent chemoradiotherapy or chemotherapy alone. Follow-up results showed that by the last follow-up, 12 cases (15.2%) had recurred and 4 cases (5.1%) were died, with a 1-year disease free survival (DFS) rate of 88.2%. ⑤Prognostic factors: univariate Cox proportional hazards regression analysis indicated that FIGO clinical stage, histological subtype, primary clinical presentation, and treatment modality were potential risk factors for mortality in patients with special type cervical adenocarcinoma (P<0.05). Inclusion of these four factors and patient age in a multivariate Cox proportional hazards regression analysis revealed that FIGO clinical stage Ⅲ-Ⅳ (HR=25.965, 95%CI: 2.260-298.000, P=0.009), and pathological subtype mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) (HR=2 033.598, 95%CI: 22.100-1.870×105, P=0.001), endometrioid adenocarcinoma (EAC) (HR=493.705, 95%CI: 17.300-1.410×104, P<0.001), and signet-ring cell carcinoma (SRCC) (HR=373.255, 95%CI: 2.010-6.930×104, P=0.026) were all independent risk factors for mortality in patients with special type of cervical adenocarcinoma (P<0.05).

Conclusions

Special type of cervical adenocarcinoma exhibits high heterogeneity, with a low incidence rate and nonspecific clinical manifestations, often leading to diagnostic challenges. This multicenter data analysis confirms that pathological subtypes and FIGO clinical staging serve as important prognostic indicators for evaluating outcomes in such patients.

Key words: Uterine cervical neoplasms, Cervical adenocarcinoma, Special types, Clinical features, Neoplasm staging, Treatment, Prognosis, Female
表1 本研究79例特殊类型宫颈腺癌患者的临床资料分析[例数(%)]
临床指标 占比 临床指标 占比
FIGO临床分期   发病年龄(岁)  
Ⅰ期 51(64.6) ≤35 5(6.3)
ⅠA期 3(3.8) 35~65 66(83.6)
ⅠB期 48(60.8) ≥65 8(10.1)
Ⅱ期 15(19.0) 首发症状  
ⅡA期 12(15.2) 阴道异常流血 43(54.4)
ⅡB期 3(3.8) 接触性出血 18(22.8)
Ⅲ期 12(15.2) 阴道不规则出血 7(8.8)
Ⅳ期 1(1.3) 绝经后流血 18(22.8)
肿瘤形态   阴道分泌物异常增多 17(21.5)
外生型 42(53.2) 体检发现 19(24.1)
内生型 30(38.0) 治疗策略  
颈管型 5(6.3) 根治性手术 76(96.2)
未知 2(2.5) 术前诱导化疗 13(16.5)
肿瘤直径(cm)   术后辅助放、化疗 35(44.3)
≤2 39(49.4) 术后免疫治疗 8(10.1)
2~4 22(27.8) 术后靶向治疗 6(7.6)
>4 18(22.8) 仅放、化疗或仅化疗 3(3.8)
表2 特殊类型宫颈腺癌患者术前腹部增强CT与术后淋巴结病理学检查结果比较及一致性检验(例)
术前CT检查 术后淋巴结病理学检查 合计
淋巴结转移 淋巴结未转移
淋巴结增大 0 3 3
淋巴结未增大 2 12 14
合计 2 15 17
表3 特殊类型宫颈腺癌患者术前盆腔增强MRI与术后淋巴结病理学检查结果比较及一致性检验(例)
术前MRI检查 术后淋巴结病理学检查 合计
淋巴结转移 淋巴结未转移
淋巴结增大 5 11 16
淋巴结未增大 1 43 44
合计 6 54 60
表4 本研究79例特殊类型宫颈腺癌患者死亡影响因素的单因素Cox比例风险回归分析
影响因素 B SE Wald值 P值 HR值 HR值95%CI
发病年龄(vs ≤35岁) － － 0.124 0.940 － －
35~65岁 0.152 1.040 0.021 0.884 1.164 0.152~8.937
≥65岁 －0.191 1.417 0.018 0.893 0.826 0.051~13.290
FIGO临床分期(vs Ⅰ期) － － 8.901 0.012 － －
Ⅱ期 0.714 0.651 1.201 0.273 2.042 0.570~7.321
Ⅲ~Ⅳ期 1.734 0.583 8.861 0.003 5.665 1.808~17.746
病理学亚型(vs GAS) － － 18.434 0.072 － －
iSMC －0.364 1.164 0.098 0.755 0.695 0.071~6.806
腺鳞癌 －1.234 1.161 1.130 0.288 0.291 0.030~2.834
VGA －13.388 473.840 0.001 0.977 2.000×10－6 0
CCC －0.080 0.924 0.007 0.931 0.924 0.151~5.654
MiNEN 2.218 0.822 7.286 0.007 9.188 1.836~45.989
EAC 0.530 0.923 0.330 0.566 1.699 0.279~10.364
ABC －13.385 901.449 2.200×10－4 0.988 2.000×10－6 0
SRCC 1.983 1.209 2.690 0.101 7.262 0.679~77.618
MA －13.284 2 707.404 2.400×10－5 0.996 2.000×10－6 0
SC 0.741 1.180 0.394 0.530 2.097 0.207~21.209
ITA 3.646 1.304 7.816 0.005 38.319 2.974~493.769
绝经状态(vs未绝经) － － 0.005 0.997 － －
已绝经 0.037 0.518 0.005 0.943 1.038 0.376~2.867
治疗方式(vs仅手术治疗) － － 6.238 0.182 － －
手术＋化疗 1.032 1.128 0.837 0.360 2.807 0.308~25.599
手术＋化疗＋放疗 1.335 1.061 1.582 0.208 3.798 0.475~30.387
化疗＋放疗 1.416 1.421 0.993 0.319 4.121 0.254~66.751
仅化疗 3.440 1.438 5.725 0.017 31.194 1.863~522.303
孕次(vs 0~1次) － － 3.935 0.415 － －
2次 －13.740 477.470 0.001 0.977 1.000×10－6 0
3次 －0.432 0.639 0.457 0.499 0.649 0.186~2.271
4次 －0.921 0.839 1.203 0.273 0.398 0.077~2.064
≥5次 0.700 0.720 0.944 0.331 2.013 0.491~8.256
产次(vs 0~1次) － － 0.346 0.841 － －
2次 0.168 0.682 0.060 0.806 1.182 0.311~4.498
≥3次 0.351 0.605 0.338 0.561 1.421 0.434~4.651
首发症状(vs阴道接触性出血) － － 4.888 0.299 － －
绝经前阴道流血 1.019 1.416 0.518 0.472 2.771 0.173~44.457
绝经后阴道出血 1.615 1.084 2.221 0.136 5.028 0.601~42.045
阴道流液 2.136 1.061 4.052 0.044 8.465 1.058~67.746
体检发现 －11.293 258.358 0.002 0.965 1.200×10－5 1.515×10－225~1.024×10215
肿瘤形态(vs外生型) － － 0.145 0.930 － －
内生型 －0.187 0.548 0.117 0.733 0.829 0.283~2.429
颈管型 0.112 1.056 0.011 0.915 1.119 0.141~8.866
肿瘤直径(vs ≤2 cm) － － 2.566 0.279 － －
2~4 cm 0.904 0.606 2.228 0.136 2.470 0.753~8.100
>4 cm 0.180 0.644 0.078 0.779 1.198 0.339~4.232
表5 本研究79例特殊类型宫颈腺癌患者死亡影响因素的多因素Cox比例风险回归分析
影响因素 B SE Wald值 P值 HR值 HR值95%CI
FIGO临床分期(vs Ⅰ期) － － 6.911 0.032 － －
Ⅱ期 1.100 1.570 0.491 0.484 3.004 0.138~65.200
Ⅲ~Ⅳ期 3.257 1.246 6.836 0.009 25.965 2.260~298.000
病理学亚型(vs GAS) － － 18.611 0.068 － －
iSMC 0.594 1.928 0.095 0.758 1.810 0.041~79.200
腺鳞癌 2.502 2.262 1.223 0.269 12.211 0.145~1 030.000
VGA －1.385 2.165 0.409 0.522 0.250 0.004~17.400
CCC 2.406 1.693 2.019 0.155 11.091 0.401~307.000
MiNEN 7.618 2.308 10.895 0.001 2 033.598 22.100~1.870×105
EAC 6.202 1.709 13.173 <0.001 493.705 17.300~1.410×104
续表5
影响因素 B SE Wald值 P值 HR值 HR值95%CI
病理学亚型(vs GAS)            
ABC 4.287 4.538 0.892 0.345 72.732 0.010~5.310×105
SRCC 5.922 2.665 4.938 0.026 373.255 2.010~6.930×104
MA 1.906 22.785 0.007 0.933 6.728 2.710×10－19~1.670×1020
SC －2.062 5.133 0.161 0.688 0.127 5.430×10－6~2 980
ITA －9.883 2 192.025 2.000×10－5 0.996 5.100×10－5 0
首发症状(vs阴道接触性出血) － － 9.941 0.041 － －
绝经前阴道流血 －0.062 1.656 0.001 0.970 0.940 0.037~24.100
绝经后阴道出血 －0.647 1.268 0.260 0.610 0.524 0.044~6.290
阴道分泌物异常增多 3.324 1.804 3.396 0.065 27.768 0.810~952.000
体检发现 －3.062 1.967 2.424 0.120 0.047 0.001~2.210
治疗方式(vs仅手术治疗) － － 1.894 0.755 － －
手术＋化疗 1.350 1.394 0.937 0.333 3.856 0.251~59.300
手术＋化疗＋放疗 1.981 1.573 1.586 0.208 7.252 0.332~158.000
化疗＋放疗 1.525 2.197 0.482 0.488 4.596 0.062~341.000
仅化疗 3.269 2.949 1.229 0.268 26.284 0.081~8 500.000
发病年龄(vs ≤35岁) － － 0.015 0.993 － －
35~65岁 －0.037 4.653 0.000 0.994 0.964 1.050×10－4~8 810
≥65岁 －0.230 4.920 0.002 0.963 0.794 5.150×10－5~1.220×104
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