With the exclusion of those that had no histopathological results, a total of 291 women were diagnosed with cervical cancer in The Third Affiliated Hospital of Sun Yat-sen University between 1st January 2017 and 31st March 2020. Of these 291 cases, 81.1% were squamous, 15.5% adenocarcinoma and 3.4% other histopathological types. The latter group was excluded from further analysis.
The characteristics of different histopathological types of cervical carcinoma were compared in Table 1. The mean age of SCC, AC and other histopathological types of cervical cancer were 50.31 ± 10.45 years, 46.44 ± 10.48 years and 56.50 ± 9.57 years. The menarche age of other histopathological types of cervical cancer (16.67 ± 6.51) was higher than that of SCC and AC(p༜0.001), while there was no significant difference between SCC(13.64 ± 1.33) and AC(13.57 ± 0.85)(p༞0.05). The majority of the patients sought medical attention for vaginal bleeding and abnormal vaginal discharge. The chief complaint of 72.0% of SCC was vaginal bleeding. 75.6% of AC came in for abnormal vaginal discharge. The HPV infection rate in AC was 72.4%, and 92.9% in SCC which was significantly higher than AC (p < 0.001). The proportion of cancer stages differed for SCC and AC significantly (p < 0.05). The percentages of stage I to IV in SCC were 28.3%, 59.9%, 9.4%, 2.4% respectively, and in AC were 46.3%, 43.9%, 4.9%, 4.9% respectively. Compared to SCC, the proportion of early-stage was significantly larger in AC (19/41, 46.3%) than in SCC (60/212, 28.3%) (p < 0.01). From the results so far, we didn’t find any significant differences of histopathological types of cervical carcinoma in age, menopausal age, marital and reproductive history (including number of pregnancies, abortions, natural births and the age of first birth or first abortion) and educational levels (p༞0.05).
In further analysis by cancer stage(Table 2), the reasons for hospitalizing behavior between SCC and AC, AC in different cancer stages, SCC in different cancer stages, SCC and AC in same cancer stage were compared. The results show that the percentage of patients with AC coming for abnormal cancer screening results was significantly higher than SCC (AC: 26.8%, SCC: 11.3%, p < 0.01). But there were no significant differences between AC in different cancer stages (early stage AC:31.6%, advanced AC: 9.1%, p = 0.070), SCC in different cancer stages (early stage SCC:18.3%, advanced SCC: 8.6%, p = 0.054), and SCC or AC in same cancer stage(p༞0.05).
Among HPV-positive cervical cancer cases, as shown in Table 3, the infection rate of HPV 16 is the highest both in SCC and AC, while the proportion of HPV-16 infection in SCC was 68.7%, significantly higher than AC (56.5%, p < 0.05). The infection rate of HPV-18 in SCC was 12.2%, significantly lower than AC (21.7%, p < 0.05). The infection rate of HPV 52,58,33,31 in SCC was 6.1%, 7.6%, 4.6% and 2.3% respectively, and the infection rate of HPV 52,31 in AC was 4.3% and 8.7%. The multiple infection rate in AC(16.8%, 22/131) was significantly lower than SCC (4.3%,1/23)(p༜0.05).
Among 214 cases with complete information about screening history and histopathological types(Fig. 2), this study found the participation rate of AC in cervical cancer screening(21.2%) was significantly higher than SCC(2.8%)(p༜0.01). The percentage of Frequent screening and Regular Screening in AC(18.2%) was also higher than SCC(1.1%)(p༜0.01). For early stage cancer, the percentage of Frequent screening and Regular Screening was significantly higher in AC(28.6%) than in SCC(3.9%)(p༜0.05), as was for advanced stages where the percentage for AC was 10.5% and 0% for SCC (p༜0.05). There was no significant difference between different cancer stages of AC in frequency of screening participation(p༞0.05), nor was there in different cancer stages of SCC(p༞0.05).