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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2026, Vol. 22 ›› Issue (02): 128 -139. doi: 10.3877/cma.j.issn.1673-5250.2026.02.005

Original Article

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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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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