CAJ | 학술논문

目的：观察HPV基因型在早期宫颈腺癌中的分布，并探讨其临床意义。方法选择2000年6月至2010年5月在浙江大学医学院附属妇产科医院保存的101例早期宫颈腺癌石蜡标本，采用巢式PCR方法对宫颈腺癌组织进行高危型HPV基因型检测，并分析HPV18基因型感染与临床病理和预后的关系。结果成功提取DNA的96例标本中，HPV阳性92例（95．8％），其中HPV16阳性57例（59．4％），HPV18阳性58例（60．4％）；HPV单一型别感染22例（22．9％），HPV双重型别感染31例（32．3％）， HPV 多重型别感染39例（40．6％），包含 HPV16、18型混合感染37例（38．5％）。 HPV18阳性与阴性者的淋巴转移、脉管内瘤栓分别为27．6％、7．9％和22．4％、7．9％，差异有统计学意义，P＜0．05。单因素分析发现手术切缘、宫旁组织浸润、淋巴转移以及HPV18阳性与早期子宫颈腺癌患者的无瘤生存和总生存时间有关。但多因素分析发现淋巴结转移是早期子宫颈腺癌患者无瘤生存时间和总生存时间的独立预后因素，而宫旁组织浸润是早期子宫颈腺癌患者总生存时间的独立预后因素。结论早期宫颈腺癌组织中常见的HPV基因型为18、16，HPV18感染与早期宫颈腺癌的淋巴转移、脉管内瘤栓有关，但与其无瘤生存时间和总生存时间无关。
목적：관찰HPV기인형재조기궁경선암중적분포，병탐토기림상의의。방법선택2000년6월지2010년5월재절강대학의학원부속부산과의원보존적101례조기궁경선암석사표본，채용소식PCR방법대궁경선암조직진행고위형HPV기인형검측，병분석HPV18기인형감염여림상병리화예후적관계。결과성공제취DNA적96례표본중，HPV양성92례（95．8％），기중HPV16양성57례（59．4％），HPV18양성58례（60．4％）；HPV단일형별감염22례（22．9％），HPV쌍중형별감염31례（32．3％）， HPV 다중형별감염39례（40．6％），포함 HPV16、18형혼합감염37례（38．5％）。 HPV18양성여음성자적림파전이、맥관내류전분별위27．6％、7．9％화22．4％、7．9％，차이유통계학의의，P＜0．05。단인소분석발현수술절연、궁방조직침윤、림파전이이급HPV18양성여조기자궁경선암환자적무류생존화총생존시간유관。단다인소분석발현림파결전이시조기자궁경선암환자무류생존시간화총생존시간적독립예후인소，이궁방조직침윤시조기자궁경선암환자총생존시간적독립예후인소。결론조기궁경선암조직중상견적HPV기인형위18、16，HPV18감염여조기궁경선암적림파전이、맥관내류전유관，단여기무류생존시간화총생존시간무관。
Objective To explore the distribution of high-risk HPV-genotypes in early-stage cervical adenocarcinoma and understand the clinical significance of HPV genotyping.Methods From June 2000 to May 2010,a total of 101 paraffin surgical specimens of cervical adenocarcinoma were genotyped by nested polymerase chain reaction ( nested PCR ) .The associations of HPV18 with clinicopathological parameters and survival were further analyzed.Results DNA extraction was successfully performed for 96 samples.The HPV-positive rate of early-stage cervical adenocarcinoma was 95.8% ( 92/96 ) .Two common HPV types were HPV16 ( 59.4%) and HPV18 ( 60.4%) .The prevalence rates of single, double and multiple HPV infections were 22.9%,32.3% and 40.6% respectively.The positive rates of lymph node metastasis and vascular involvement with HPV18 infection were 27.6%and 22.4%versus 7.9%and 7.9%for those without HPV18 infection.Univariate analysis showed that positive surgical margin, uterine corpus invasion,lymph node metastasis and HPV18 infection were the predictive factors for poor prognosis of patients with cervical adenocarcinoma.Multivariate analysis revealed that lymph node metastasis was an independent prognostic factor for both disease-free and overall survivals.And uterine corpus invasion was an independent prognostic factor of overall survival for early-stage cervical adenocarcinoma patients.Conclusion HPV16 and HPV18 are major types responsible for early-stage cervical adenocarcinoma.Infection with HPV18 is prone to lymph node metastasis and vascular involvement.However,there is no correlation with disease-free survival or overall survival.