Copeland L J, Silva E G, Gershenson D M, Morris M, Young D C, Wharton J T
Department of Gynecology, University of Texas, M. D. Anderson Cancer Center, Houston.
Gynecol Oncol. 1992 Jun;45(3):307-12. doi: 10.1016/0090-8258(92)90310-f.
The microscopic pathologic features of early invasive squamous cell cervical carcinoma are used as determinants for the treatment of these lesions. This study is a retrospective review of 180 patients with squamous cell cervical carcinoma with invasion to a depth of 5 mm or less. Invasion of less than or equal to 1 mm, greater than 1 but less than or equal to 3 mm, greater than 3 but less than or equal to 5 mm was noted in 37, 84, and 59 patients, respectively. The median follow-up was 6.5 years. Four (2.2%) patients developed carcinoma in situ of the vagina and four (2.2%) patients progressed to invasive squamous carcinoma. Pelvic lymph node metastases were rare (1%). No patient has died from recurrent disease. Analysis of numerous clinical and pathological variables identified no risk factors for recurrence. Most (54/68) patients with tumor invading beyond 3 mm or with tumor demonstrating vascular invasion were treated by traditional "radical" methods. This limited a meaningful analysis of the risk of conservative treatment. The reliability of using the existing definitions of microinvasive disease for the guidance of treatment remains controversial. Further clarification may be rendered only with prospective clinical-pathologic studies performed by cooperative groups.
早期浸润性宫颈鳞状细胞癌的微观病理特征被用作这些病变治疗方案的决定因素。本研究对180例浸润深度为5mm及以下的宫颈鳞状细胞癌患者进行了回顾性分析。分别有37、84和59例患者的浸润深度小于或等于1mm、大于1但小于或等于3mm、大于3但小于或等于5mm。中位随访时间为6.5年。4例（2.2%）患者发生阴道原位癌，4例（2.2%）患者进展为浸润性鳞状细胞癌。盆腔淋巴结转移少见（1%）。无患者死于复发疾病。对众多临床和病理变量的分析未发现复发的危险因素。大多数（54/68）肿瘤浸润超过3mm或显示血管浸润的患者采用传统的“根治性”方法治疗。这限制了对保守治疗风险的有意义分析。使用现有的微浸润疾病定义来指导治疗的可靠性仍存在争议。只有通过合作组进行前瞻性临床病理研究才能进一步阐明。
