研究目的

本研究旨在分析宫颈癌患者的一般人口学特征、病理类型分布、分期特点及其相关影响因素，并探讨细胞学和阴道镜检查在宫颈鳞癌（SCC）和宫颈腺癌（ADC）诊断中的临床效能，以期为宫颈癌的早期筛查、诊断和治疗提供科学依据。 

材料与方法

本研究共纳入2013年-2022年中国人民解放军总医院第一医学中心912例宫颈癌患者，收集其人口学资料、病理类型、分期信息及细胞学和阴道镜检查结果。通过单因素和多因素分析，探讨影响宫颈癌病理类型和分期的影响因素。采用卡方检验和Logistic回归分析评估细胞学和阴道镜检查在SCC和ADC诊断中的一致性及临床效能。使用SPSS 24.0和Prison等软件进行数据分析。

研究结果

宫颈癌患者的平均年龄为50.44岁，主要病理类型为SCC（82.89%），其次是ADC（12.06%）。I期患者占比52.74%，II-IV期患者占比47.26%。多因素分析显示，职业类型是影响SCC的独立影响因素（企/事业单位从业者风险较低，OR=0.56，P=0.03）；而首诊年龄、绝经状态、职业类型和筛查途径是影响宫颈癌分期的独立影响因素（与23-35岁组相比，46-55岁（OR=5.53，P<0.01）、56-65岁（OR=4.41，P=0.01）和≥66岁（OR=4.13，P=0.03）的患者宫颈癌分期风险显著增加；绝经患者的宫颈癌分期风险较高（OR=1.92，P=0.03）、与无业患者相比，职业为“其他”类别的患者宫颈癌分期风险降低（OR=0.36，P=0.02）、与自身症状相比，经筛查确诊的患者宫颈癌分期风险降低（OR=0.49，P=0.02））。细胞学检查对SCC的诊断一致性较高（79.46%异常病变），但对ADC的诊断可能存在较高的漏诊或误诊风险（34.88%阴性结果）；阴道镜检查在SCC和ADC的癌变检出率相近（64.12% vs. 56.67%），但对ADC的可疑癌变识别可能存在一定差异（20.00% vs. 9.41%）。

研究结论

宫颈鳞状细胞癌是宫颈癌的主要病理类型，中晚期患者比例仍较高。首诊年龄、职业类型、绝经状态和筛查途径是影响宫颈癌分期的重要影响因素。细胞学检查对SCC的诊断效能较高，但对ADC的诊断存在一定局限性；阴道镜检查在识别癌变方面具有较高的效能，但对ADC的可疑癌变识别可能存在差异。未来应结合多种诊断手段，优化宫颈癌筛查和诊断流程，特别是针对ADC的早期识别和精准诊断，以改善患者预后。

Objectives: The purpose of this study was to analyze the general demographic characteristics, distribution of pathological types, staging characteristics and related influencing factors of cervical cancer patients, and to explore the clinical efficacy of cytology and colposcopy in the diagnosis of cervical squamous cell carcinoma (SCC) and cervical adenocarcinoma (ADC), in order to provide a scientific basis for the early screening, diagnosis and treatment of cervical cancer. Methods: A total of 912 patients with cervical cancer in the First Medical Center of the General Hospital of the Chinese People's Liberation Army from 2013 to 2022 were included in this study, and their demographic data, pathological type, staging information, cytology and colposcopy results were collected. Univariate and multivariate analyses were used to explore the influencing factors affecting the pathological type and stage of cervical cancer. Chi-square test and logistic regression analysis were used to evaluate the consistency and clinical efficacy of cytology and colposcopy in the diagnosis of SCC and ADC. Data analysis was performed using software such as SPSS 24.0 and Prison. Results: The average age of cervical cancer patients was 50.44 years, and the main pathological type was SCC (82.89%), followed by ADC (12.06%). Stage I patients accounted for 52.74% and stage II-IV patients accounted for 47.26%. Multivariate analysis showed that occupation type was an independent influencing factor for SCC (the risk of employees in enterprises/institutions was low, OR=0.56, P=0.03). Age at first diagnosis, menopausal status, occupational type, and screening route were independent influencing factors for cervical cancer staging (compared with the 23-35 age group, 46-55 years old (OR=5.53, P Patients aged <0.01), 56-65 years (OR=4.41, P=0.01) and ≥66 years (OR=4.13, P=0.03) had significantly increased risk of cervical cancer staging. Compared with unemployed patients, the risk of cervical cancer staging was higher in postmenopausal patients (OR=1.92, P=0.03), compared with unemployed patients, the risk of cervical cancer staging in patients with occupation in the "other" category was reduced (OR=0.36, P=0.02), and the risk of cervical cancer staging was reduced in patients diagnosed by screening compared with their own symptoms (OR=0.49, P=0.02). Cytology had a high agreement in the diagnosis of SCC (79.46% of abnormal lesions), but there may be a high risk of missed or misdiagnosed ADC (34.88% negative results). The detection rate of carcinogenesis in SCC and ADC was similar in colposcopy (64.12% vs. 56.67%), but there may be some differences in the identification of suspected carcinogenesis in ADC (20.00% vs. 9.41%). Conclusions: Squamous cell carcinoma of the cervix is the main pathological type of cervical cancer, and the proportion of patients with intermediate and advanced stages is still high. Age at first diagnosis, type of occupation, menopausal status and screening route are important influencing factors affecting the staging of cervical cancer. Cytology has high diagnostic efficacy in the diagnosis of SCC, but has certain limitations in the diagnosis of ADC. Colposcopy has a high efficacy in identifying cancer, but there may be differences in the identification of suspected cancers in ADCs. In the future, it is necessary to combine a variety of diagnostic methods to optimize the screening and diagnosis process of cervical cancer, especially for the early identification and accurate diagnosis of ADC, so as to improve the prognosis of patients.