Gadducci A, Sartori E, Maggino T, Landoni F, Zola P, Cosio S, Pasinetti B, Alessi C, Maneo A, Ferrero A
Department of Gynecology and Obstetrics, University of Pisa, Italy.
Eur J Gynaecol Oncol. 2003;24(6):513-6.
The objective of this retrospective multicenter study was to assess the clinical outcome of patients with microinvasive squamous cell carcinoma of the uterine cervix.
The hospital records of 166 patients with microinvasive squamous cell carcinoma of the uterine cervix were reviewed. All cases were retrospectively staged according the 1994 International Federation of Gynecology and Obstetrics (FIGO) nomenclature. One hundred and forty-three cases were in Stage Ia1 and 23 in Stage Ia2 disease. Surgery consisted of conization alone in 30 (18.1%) patients, total hysterectomy in 82 (49.4%), and radical hysterectomy in 54 (32.5%). All patients in whom conization was the definite treatment had Stage Ia1 disease and had cone margins negative for intraepithelial or invasive lesions.
None of the 67 patients submitted to pelvic lymphadenectomy had histologically proven metastatic lymph nodes. Of the 166 patients, eight (4.8%) had an intraepithelial recurrence and four (2.4%) had an invasive recurrence. With regard to FIGO substage, disease recurred in nine (6.3%) out of 143 patients with Stage Ia1 and three (13.0%) out of 23 with Stage Ia2 cervical cancer. With regard to type of surgery, disease recurred in three (10.0%) out of the patients treated with conization alone, four (4.9%) out those who underwent total hysterectomy, and five (9.3%) out of those who underwent radical hysterectomy. It is worth noting that none of the 30 patients treated with conization alone had recurrent invasive cancer after a median follow-up of 45 months. However three (10%) of these patients developed a cervical intraepithelial neoplasia (CIN) III after 16, 33, and 94 months, respectively, from conization.
Conization can represent the definite treatment for patients with Stage Ia1 squamous cell cervical cancer, if cone margins and apex are disease-free. For patients with Stage Ia2 cervical cancer extrafascial hysterectomy with pelvic lymphadenectomy might be an adequate standard therapy, although the need for lymph node dissection is questionable.
这项回顾性多中心研究的目的是评估子宫颈微浸润鳞状细胞癌患者的临床结局。
回顾了166例子宫颈微浸润鳞状细胞癌患者的医院记录。所有病例均根据1994年国际妇产科联合会（FIGO）的命名法进行回顾性分期。143例为Ia1期，23例为Ia2期。手术方式包括单纯锥切术30例（18.1%），全子宫切除术82例（49.4%），根治性子宫切除术54例（32.5%）。所有接受锥切术作为明确治疗的患者均为Ia1期，锥切边缘上皮内或浸润性病变阴性。
67例行盆腔淋巴结清扫术的患者中，均未在组织学上证实有转移淋巴结。166例患者中，8例（4.8%）发生上皮内复发，4例（2.4%）发生浸润性复发。就FIGO亚分期而言，143例Ia1期宫颈癌患者中有9例（6.3%）复发，23例Ia2期宫颈癌患者中有3例（13.0%）复发。就手术类型而言，单纯接受锥切术治疗的患者中有3例（10.0%）复发，接受全子宫切除术的患者中有4例（4.9%）复发，接受根治性子宫切除术的患者中有5例（9.3%）复发。值得注意的是，单纯接受锥切术治疗的30例患者在中位随访45个月后均未出现复发性浸润癌。然而，其中3例（10%）患者分别在锥切术后16、33和94个月发生了宫颈上皮内瘤变（CIN）III级。
对于Ia1期子宫颈鳞状细胞癌患者，如果锥切边缘和顶端无病变，锥切术可作为明确的治疗方法。对于Ia2期宫颈癌患者，筋膜外子宫切除术加盆腔淋巴结清扫术可能是一种合适的标准治疗方法，尽管淋巴结清扫的必要性存在疑问。
