The Clinical And Histopathological Analysis Study Of Cervical Squamous Carcinoma Stage â… A1

Purpose This research through the retrospective analysis of 1995-2011,the stage ⅠA1cervical squamous cell carcinomas in patients weth clinical and pathological data, to explore the prognosis of different treatments, and through the D2-40,CD34 andβ-catenin antibody immunohistochemical staining to determine LVSI,clear blood clearance of invasion and lymphatic clearance infiltration,improve the diagnostic rate of LVSI,for the future clinical treatments for LVSI,for stage ⅠA1 period clinical standardized treatment of cervical squamous carcinoma provide reference opinions.And individualized treatment,according to the patient’s condition is not only more effective treatment of early cervical squamous carcinoma,to prevent further progression lesions,and to improve the patient’s quality of life.Research Methods:Clinicopathological data of 346 cases SCC diagnosed between November 2nd1995 and December 31 th 2011 were reviewed and analyzed. Figure out the change of its diagnosis and treatment, analyze the prognosis of various treatments and cases with lymphovascular space invasion(LVSI).Slides out the 2009-2010 cases of the stage ⅠA1 cervical squamous carcinoma surgery pathological,please department a pathology doctor of department of hihg qualification review cases of pos toperative slides, to determine the LVSI/HE.With D2-40,CD34 and β-catenin antibodies in ⅠA1 period for immunohistochemical staining in cervical spuamous cell carcinomas(S-P method), immunohistochemical experiments done in pathology,the first hospital of immunohistochemical chamber.Results:(1) Diagnostic method: 2%(7/346) patients were diagnosed with loop electrosurgical excision procedure(LEEP), 44.5%(154/346) with cold knifeconization(CKC), 1.7%(6/346)with vaginal trachelectomy(VT), 29.5%(102/346)with extrafascial hysterectomy(EH), 21.4%( 74/346) with modified radical hysterectomy(MRH), 0.9%(3/346)with radical trachelectomy(RT).Final surgical method: 12.7%(44/346) patients were treated with CKC, 2.0%(7/346) with VT,58.1%(201/346) with EH, 26.0%(90/346) with MRH, 1.2%(4/346) wtih RT.(2) The change of therapy: CKC increased year by year and MRH decreased obviously. No obviously change has been detected on EH and almost no change has taken place on VT and RT due to the very small number cases.(3) Prognosis: The median follow-up time of these patients was 66m(range2m~159m) and the follow-up rate was 93.4%(323/346).The overall survival rate was 99.0%. 2 patients suffered pelvic recurrence and 2 underwent distant metastasis.The total recurrence rate was 1.2%(4/346). The 2 patients with distant metastasis had died and the case fatality rate was 0.6%(2/346)。The total survival rates for CKC、VT、EH、MRH and RT were 100%、100%、98.2%、100% and 100%,the difference was not statistically significant(P=0.819). The incidence rate of LVSI was4.9%(17/346), the total survival rates for the patient with LVSI and those without LVSI were 99.3% and 93.3% respectively, and there was statistical difference between them(P=0.003), Univariate analysis showed that LVSI was an important predictor for survival(P=0.030). Conclusions: More conservative treatment was an reasonable option for Stage IA1 SCC. Personal therapy and more frequent surveillance should be administrated to those patients with LVSI, because LVSI was an important predictor for survival.(4) immunohistochemical results: by using D2-40, CD34 and beta- catenin antibody immunohistochemical study, comparing HE staining and immuneohistochemical staining in vascular tumor emboli detection rate, the results showed that 6 cases(6.19%) of the sample HE staining positive, 18 cases(11.34%)monoclonal antibody immunohistochemical staining positive beta catenin sample,immunohistochemical staining of vascular tumor emboli was much higher than that of HE staining, compared with HE sliced detection rate increased(12.37%),statistically significant difference(P < 0.05).HE sliced, the total number of cases of LVI detection for 4 cases, BVI checked out of the total number of cases for 2 cases,40 immunohistochemical staining with CD34 and D2- tag after blood vessels and lymphatic vessels, to determine the LVSI, and distinguish between infiltration(BVI)and lymphatic vascular space invasion(LVI).Immunohistochemical staining showed:D2-40 expression of lymphatic vessel invasion(LVI) clearance 12 cases(12.37%),vascular wall is thin, most of the incomplete, irregular shape, tube cavity sizes and tube wall for simple squamous epithelium, no muscular layer, and no red blood cells and neutrophils fill, conform to the lymphatic morphological characteristics.CD34 expression of blood clearance invasion 8 cases(8.25%), mostly lumen is not complete,has a tendency to form blood vessels.For the BVI + LVI both positie in 2 cases(2.06%).HE staining of vascular invasion and lymphatic clearance gap infiltration false negative rate were 7.21%, 7.21%, false positive rate of 2.06%, 1.03%respectively.(5)LVSI/IHC and other clinical pathologic factors on prognosis of cervical squamous cell carcinomas of Ⅰ A1: the effect of 97 cases, 1 case of pelvic recurrence and distant metastasis in 1 case, 1 case distant metastasis patients have died.2 cases were pelvic recurrence and distant metastasis, LVSI/IHC positie and LVI BVI +positive patients.Analysis of immunohistochemical staining to determine LVSI and other clinical pathologic factors on prognosis of cervical squamous cell carcinomas ofⅠ A1 influence of related factors such as age, the final operation, LVSI and diagnosis of postoperative cutting edge, the final postoperative cutting edge, lymph node metastasis into the Cox proportional hazards model with single factor analysis, the result shows: LVSI/IHC(P = 0.040), LVI(P = 0.320), BVI + LVI(P = 0.210) are the important factors that affect prognosis,(see chart 11).Multiariable Logistic regression analysis showed, LVSI/IHC(OR = 3.632, P < 0.05), BVI + LVI(OR = 5.024, P <0.05) the risk factors affecting prognosisConclusion:More conservative treatment was an reasonable option for Stage IA1 SCC.Personal therapy and more frequent surveillance should be administrated to those patients with LVSI, because LVSI was an important predictor for survival.D2-40,CD34andβ-catenin antibody immunohistochemical staining, the diagnosis ofinfiltrating the feasibility of the lymphatic vessels clearance and clarify its detection rate is higher than HE staining,LVSI as a poor prognosis indexes,is to estimate disease prognosis,and develop targeted therapies as well as one of the important indexes of objective evaluation of curative effect.