妊娠合并子宫颈浸润癌的管理：治疗延迟的结局

Management of invasive carcinoma of the uterine cervix associated with pregnancy: outcome of intentional delay in treatment.

作者信息

Takushi Minako, Moromizato Hidehiko, Sakumoto Kaoru, Kanazawa Koji

机构信息

Department of Obstetrics and Gynecology, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.

出版信息

Gynecol Oncol. 2002 Nov;87(2):185-9. doi: 10.1006/gyno.2002.6813.

DOI:10.1006/gyno.2002.6813

PMID:12477449

Abstract

OBJECTIVE

To investigate patients with invasive cervical carcinoma associated with pregnancy, with special reference to the maternal and neonatal outcomes after planned treatment delay to improve fetal maturity.

METHODS

The medical records of 28 patients with invasive cervical carcinoma diagnosed during pregnancy or within 1 month after pregnancy were retrospectively reviewed.

RESULTS

Twenty-two patients (79%) had Stage I disease and 6 (21%) had Stage II or III disease. Tumor histology revealed squamous cell carcinoma in 27 cases and adenocarcinoma in 1. Twenty cases were diagnosed before 22 weeks gestation, 4 between 22 and 36 weeks, 1 after 36 weeks gestation, and 3 were diagnosed postpartum. In the immediate treatment group (n = 16), the diseases were Stage IA in 3 cases, IB in 7, and II or III in 6. In 11 patients, hysterectomy was performed after therapeutic abortion or with fetus in situ. In 2 patients, cesarean section was followed by hysterectomy or radiotherapy. Three patients diagnosed postpartum were treated with either hysterectomy or radiotherapy. Fifteen patients were free of disease during the follow-up of 27 to 114 months. In the delayed treatment group (n = 12), the diseases were Stage IA1 in 8 cases, IA2 in 1, IB1 in 2, and IB2 in 1 case. In 8 patients with Stage IA1 tumor, the treatment was deferred until term with a delay of 6 to 25 weeks, and hysterectomy or therapeutic conization was performed after delivery. In 4 patients with Stage IA2, IB1 or IB2 tumor, the treatment was postponed until after 30 weeks gestation with a delay of 6 to 15 weeks. No disease progression was documented. Cesarean delivery was followed by hysterectomy in these patients. All patients were free from disease during the follow-up of 70 to 156 months and their babies were well with no sequelae.

CONCLUSION

Delay in treatment to allow for fetal maturity is safe in patients with early Stage I cervical carcinoma associated with pregnancy.

摘要

目的

研究妊娠合并浸润性宫颈癌患者，特别关注计划推迟治疗以提高胎儿成熟度后的母婴结局。

方法

回顾性分析28例在孕期或产后1个月内诊断为浸润性宫颈癌患者的病历。

结果

22例（79%）为Ⅰ期疾病，6例（21%）为Ⅱ期或Ⅲ期疾病。肿瘤组织学显示27例为鳞状细胞癌，1例为腺癌。20例在妊娠22周前诊断，4例在22至36周之间诊断，1例在妊娠36周后诊断，3例在产后诊断。在立即治疗组（n = 16）中，3例为ⅠA期疾病，7例为ⅠB期，6例为Ⅱ期或Ⅲ期。11例患者在治疗性流产后或胎儿原位时进行了子宫切除术。2例患者在剖宫产术后进行了子宫切除术或放疗。3例产后诊断的患者接受了子宫切除术或放疗。15例患者在27至114个月的随访期间无疾病。在延迟治疗组（n = 12）中，8例为ⅠA1期疾病，1例为ⅠA2期，2例为ⅠB1期，1例为ⅠB2期。8例ⅠA1期肿瘤患者的治疗推迟至足月，延迟6至25周，分娩后进行子宫切除术或治疗性锥切术。4例ⅠA2期、ⅠB1期或ⅠB2期肿瘤患者的治疗推迟至妊娠30周后，延迟6至15周。未记录到疾病进展。这些患者在剖宫产术后进行了子宫切除术。所有患者在70至156个月的随访期间均无疾病，其婴儿状况良好，无后遗症。