| Background:Cervical cancer is the third leading cause of cancer death in women.It was estimated that529,512women were Diagnosed with cervical cancer corresponding to an annual Age Standardized Incidence Rate (ASIR) of15.4/100,000. An estimated274,967women died of the disease,with an annual Age Standardized Mortality Rate (ASMR) of7.8/100,000. The majority of cases (85.5%) and deaths (85.5%) were found in developing countries[1,2].Cervical cancer is one of the few malignant tumors which can be prevented and stopped at pre-malignant stage. It has been several decades since the CC screening guideline was first introduced. Now, it is a relatively rare disease in high resource countries which have well-organized, well-controlled, high-quality cervical cytology screening programs with good coverage of the appropriate target population. However, most less resource countries use an opportunistic program to detect cervical cancer (CC), which includes only women who visit their gynecologist, no matter what the reason. As this detection program does not include a large part of the risk population, it cannot significantly decrease the CC incidence and mortality rate.With the promoting of CC screening programs all over the world, clinical and pathological characteristics including diagnosed age, Reproductive history, cell differentiation, histology, FIGO stage, surgical risk factors and treatment patterns also have greatly changed in the past few decades. Adenocacinoma of the cervix currently accounts for20-25%of all cervical cancers, which is significantly higher than the incidence of5-10%observed in the1970s[4-6].Early-stage cervical cancer has significantly increased during the past few years, with a younger diagnosed age. Many research show that about15-25%of the newly diagnosed cervical cancer patients were at an reproductive age[7,8]. Yet, the treatment of cervical cancer is mostly depended on FIGO stage and prognostic risk factors. Traditional surgery for CC is radical hysterectomy with pelvic lymph node dissection. Having more patients who desire fertility preservation and ovarian preservation, our surgical options would have to change. Proper combinations of surgical methods, concurrent radio-chemotherapy, radio therapy and Neoajuvant-chemotherapy, as ways of synthetic treatment, is becoming the new trend.A great diversity in incidence and treatment of cervical cancer is observed between, as well as within countries, largely relate to a variability in economy and the existence or not of well-organized cervical cytology screening programs. In Zhejiang, a relatively developed province located in the South-east of china, organized cervical cancer screening programs have been introduced in most cities. Understanding the clinical-pathological features and treatments in Zhejiang province would have a referential meaning in making prevention and control decisions of CC in china. In our study, We studied the clinical-pathological characteristics and treatment patterns of newly diagnosed CC cases in5hospitals in Zhejiang province during the period2000to2009,to evaluate the trends of clinical-pathological characteristics and treatments after the introduction of cervical screening program.Materials and Methods:We retrospectively study2828patients diagnosed with invasive cervical cancer at Women’s Hospital of Zhejiang University, No1hospital of Wenzhou University, Taizhou Hospital,Wenzhou cancer hospital and NO2hospital of Wenzhou between January2000and December2009. Clinical-pathological factors including age, Reproductive history, cell differentiation, histology, FIGO stage, surgical risk factors were analyzed, as well as primary treatment and Surgical approach. Results:1. In the period of observation, the diagnosed age of cervical cancer is between18to91years old, with a median diagnosed age of45years old. Women at35and younger were diagnosed in416cases(14.7%),women at65and older were diagnosed in221(7.8%).2. Cervical cancer patients with no reproductive history were present in90(3.2%). Early stage la of cervical cancer was observed in464women(16.4%); Squamous cell carcinoma was present in2493women (88.2%), adenocarcinoma in206(7.3%), adenosquamous carcinoma in71(2.5%) and other types in32women (1.3%).3. Stage IA and IB are the main clinical stage in Younger patients of CC(74.5%).Squamouscarcinoma is more presented in the older patients of CC. Low grade carcinoma is more presented in younger patients(13.9%) than the median (11.9%) and old(7.3%) age group.4. Younger CC group is significantly more frequently diagnosed with early stage cervical cancer than median and old age group (χ2=31.97, P<0.0001;χ2=175.4, P <0.0001).Histological type is significantly different between age groups (χ2=12.46, P=0.006;χ2=7.842, P=0.0494).Cell grade is significantly different between age groups (χ2=6.957, P=0.0309;χ2=12.09, P=0.0024)5. Deep stromal invasion is significantly different between the older group and the younger, median age group of CC (χ2=25.44, P<0.0001;χ2=17.18, P<0.0001).Positive surgical margin is also significantly different between age groups (χ2=5.422, P=0.0199; χ2=18.6, P<0.0001)6. Among the2686CC patients who received primary treatment, Surgery was performed in2168women (80.7%),neoajuvent chemotherapy(NACT) in250women (9.3%) and radiotherapy/radio-chemotherapy in268women (10.0%).NACT is mainly performed in IB2and IIA stage(),women>65were more likely to receive radiotherapy rather than surgery as their primary treatment.7. Patients in different age groups and clinical stages had significant differences in primary treatments (χ2=769.8, P<0.0001; χ2=138.7, P<0.0001).But not in different histology-type groups (χ2=7.842, P=0.0976)8. Fertility sparing surgery is mainly performed in IA stage cervical cancer, radical hysterectomy is the main surgical approach in IB-IIB stage cervical cancer;13.1%of youner CC patients receive fertility sparing surgery and34.1%receive ovarian preservation surgery.9. Surgical approach is significantly different in patients with different clinical stages and age groups (x2=425.5, P<0.0001; x2=126.6,p<0.0001),not with different histology type (x2=5.181, P=0.2692)Conclusion:1. Squamous cell carcinoma still takes a major part of cervical cancer with quite a number of young and early-stage cases, which shows the effect of CC screening program.2. Younger patients of cervical cancer has higher proportion in adenocarcinoma, low tumor grade and early stage of CC, but lower proportion in surgical risk factors.3. More than80%of the cervical cancer cases choose surgery as their primary treatment, FIGO stage and age are the main factors in treatment decision making.1.4.4.7%of the surgery approach is either cone biopsy or trachelectomy and pelvic lymph node dissection, fastening on the young and stage I CC patients, which fits the international trend.2.5.12.2%of the patients with stage IB-IIB undergo NACT, which has became one of the accepted option for treating locally advanced CC in Zhejiang province. |
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