Objective: To analyze the 13 years trend in proportion, risks factors and clinicopathological characteristics of young women with stage Ⅰa2 to Ⅱa2 cervical cancer by using multi-center data of cervical cancer in China. Methods: The clinicopathological data of 46 313 patients with cervical cancer treated from 37 hospitals in China were obtained from January 2004 to December 2016. Using clinical and pathologic data, each patient's stage was reclassified by the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system. A total of 19 041 patients were selected according to the following criteria: FIGO stage Ⅰa2 to Ⅱa2, underwent type B or C radical hysterectomy and pelvic lymphadenectomy. All the patients were divided into two groups: the study group of 1 888 patients aged 35 years or younger and the control group of 17 153 patients aged over 35 years. The 13 years trend in proportion of young women with stage Ⅰa2 to Ⅱa2 cervical cancer, risks factors and clinicopathological characteristics of two groups were retrospectively analyzed. Results: (1) The total number of hospitalized patients with stage Ⅰa2 to Ⅱa2 cervical cancer increased annually. However, a downward trend of patients aged 35 years or younger was observed (P<0.01) . The constituent ratio of patients aged 35 years or younger was significantly greater during 2004-2010 than that during 2011-2016 [12.6% (820/6 484) and 8.5% (1 068/12 557) , respectively; χ(2)=82.101, P<0.01]. (2) Compared with patients aged over 35 years, patients aged 35 years or younger had an earlier age at menarche, a later age at marriage, lesser gravida and parity (all P<0.01). The positive rate of high-risk HPV infection was not statistically different between two groups (all P>0.05). (3) The proportions of stage Ⅰ, exophytic type and non-squamous histological type in patients aged 35 years or younger were clearly higher than those in patients aged over 35 years (83.4% vs 68.5%, P<0.01; 63.2% vs 56.2%, P<0.01; 13.9% vs 12.0%, P<0.05, respectively). Whereas the poor differentiation ratios of the two groups had no statistical significance (P>0.05). (4) As for the postoperative pathological risk factors, the rate of surgical margin involvement in patients aged 35 years or younger was lower than that aged over 35 years (1.1% vs 1.8%, P<0.05), and the rate of depth of stromal invasion >1/2 in patients aged 35 years or younger was lower than that in patients aged over 35 years (40.1% vs 50.9%, P<0.01). In addition, there were no significant difference in parametrial margin involvement, tumor size and lymph vascular space invasion between two groups (all P>0.05). Conclusions: The trend in proportion among hospitalized patients for stage Ⅰa2 to Ⅱa2 cervical cancer in young women is decreasing yearly. Compared with cervical cancer in middle-aged and elderly women, cervical cancer in young women have an earlier age at menarche, a higher proportion of stage Ⅰ patients and non-squamous histological type. In terms of the postoperative pathological risk factors, the rate of surgical margin involvement and depth of stromal invasion >1/2 in young women with cervical cancer are lower than in middle-aged and elderly women.
目的： 探讨年轻Ⅰa2~Ⅱa2期子宫颈癌患者的构成比变化趋势及临床病理特征。 方法： 收集2004年1月—2016年12月共13年间中国11省市37家三级甲等医院收治的46 313例子宫颈癌患者的临床病理资料，按照2018年国际妇产科联盟（FIGO）的临床分期标准进行重新分期，选择期别为Ⅰa2~Ⅱa2期、行B型或C型子宫切除+盆腔淋巴结切除术的子宫颈癌患者共19 041例，其中年龄≤35岁的年轻患者1 888例（≤35岁组），年龄>35岁的中老年患者17 153例（>35岁组），分析2004—2016年的13年间年轻Ⅰa2~Ⅱa2期子宫颈癌患者的构成比变化趋势，并比较两组患者发病相关因素、临床病理特征的差异。 结果： （1）2004—2016年的13年间，≤35岁组患者的构成比呈显著下降趋势（χ(2)(趋势)=119.543，P<0.01）；在≤35岁组患者中，2004—2010年间的构成比明显高于2011—2016年间[分别为12.6%（820/6 484）、8.5%（1 068/12 557）；χ(2)=82.101，P<0.01]。（2）与>35岁组患者比较，≤35岁组患者的初潮年龄较早、结婚年龄较晚、孕次和产次较少，分别比较，差异均有统计学意义（P<0.01）；而两组间高危型HPV阳性率比较，差异则无统计学意义（P>0.05）。（3）与>35岁组患者比较，≤35岁组患者中临床分期Ⅰ期（分别为68.5%、83.4%）、外生型肿瘤（分别为56.2%、63.2%）、非鳞癌（分别为12.0%、13.9%）所占比例均较高，分别比较，差异均有统计学意义（P<0.05）；而两组间低分化所占比例比较，差异则无统计学意义（P>0.05）。（4）与>35岁组患者比较，≤35岁组患者中切缘阳性（分别为1.8%、1.1%）、间质浸润深度>1/2（分别为50.9%、40.1%）所占比例均较低，分别比较，差异均有统计学意义（P<0.05）；而宫旁浸润、肿瘤直径、淋巴脉管间隙浸润方面，两组间分别比较，差异均无统计学意义（P>0.05）。 结论： 2004—2016年的13年间，年轻的Ⅰa2~Ⅱa2期子宫颈癌患者的构成比呈显著下降趋势。相对于中老年患者，年轻的Ⅰa2~Ⅱa2期子宫颈癌患者的初潮年龄较早、Ⅰ期和非鳞癌比例较高，在术后病理危险因素方面，年轻患者的切缘阳性和深间质浸润比例较低。.
Keywords: Age factors; Carcinoma, squamous cell; Neoplasm invasiveness; Neoplasm staging; Papillomavirus infections; Uterine cervical neoplasms.