Yamaguchi H, Ueda M, Kanemura M, Izuma S, Nishiyama K, Tanaka Y, Noda S
Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
Int J Gynecol Cancer. 2007 Mar-Apr;17(2):455-9. doi: 10.1111/j.1525-1438.2006.00868.x. Epub 2007 Feb 19.
The objective of this study was to evaluate the clinical efficacy of conservative laser therapy for early-stage cervical cancer. Seven hundred fifty-two and 271 patients with carcinoma in situ (CIS) and microinvasive squamous cell carcinoma (MIC), respectively, were treated by laser conization with vaporization. One hundred eighty-four patients with preclinical invasive diseases underwent radical surgery without conization. Their postoperative histologic findings and clinical outcomes were evaluated retrospectively. The cone specimens of 1023 cases were reported as showing that 54 had dysplasia, 663 had CIS, 239 had stage Ia1 without lymph vascular space invasion (LVSI), 14 had stage Ia1 with LVSI, 14 had stage Ia2, and 39 had stage Ib1 diseases. Incomplete excision occurred in 4 (7.4%) of 54 dysplasia, 48 (7.2%) of 663 CIS, and 16 (6.7%) of 239 stage Ia1 cases, but failure rates were only 1 (1.9%), 8 (1.2%), and 4 (1.7%), respectively. The other 67 of 1023 cases underwent abdominal operation. Final pathology results were analyzed for 67 and 184 cases with stages Ia1 to Ib1 receiving radical surgery with or without initial laser therapy. Lymph node metastasis was not observed in 154 Ia1 and 30 Ia2 with stromal invasion of under 4 mm in depth regardless of LVSI, but was detected in 2 of 16 Ia2 with stromal invasion of over 4 mm in depth and in 9 of 51 Ib1 cases. CIS and Ia1 disease without LVSI can be treated only by laser therapy. The limit of stromal invasion for conservative laser therapy in stage Ia cancer may be 4 mm in depth regardless of LVSI.
本研究的目的是评估保守性激光治疗早期宫颈癌的临床疗效。分别对752例原位癌（CIS）患者和271例微浸润鳞状细胞癌（MIC）患者进行了汽化性激光锥切术治疗。184例临床前期浸润性疾病患者未行锥切术而直接接受了根治性手术。对他们的术后组织学检查结果和临床结局进行了回顾性评估。1023例患者的锥切标本报告显示，54例有发育异常，663例有原位癌，239例为无淋巴血管间隙浸润（LVSI）的Ia1期，14例为有LVSI的Ia1期，14例为Ia2期，39例为Ib1期疾病。54例发育异常患者中有4例（7.4%）、663例原位癌患者中有48例（7.2%）、239例Ia1期患者中有16例（6.7%）出现切除不完全，但失败率分别仅为1例（1.9%）、8例（1.2%）和4例（1.7%）。1023例中的其他67例患者接受了腹部手术。对67例和184例接受了根治性手术（无论是否先行激光治疗）的Ia1至Ib1期患者的最终病理结果进行了分析。无论有无LVSI，154例Ia1期和30例深度间质浸润小于4mm的Ia2期患者均未观察到淋巴结转移，但在16例深度间质浸润超过4mm的Ia2期患者中的2例以及51例Ib1期患者中的9例中检测到了淋巴结转移。无LVSI的CIS和Ia1期疾病仅可通过激光治疗。无论有无LVSI，Ia期癌症保守性激光治疗的间质浸润深度极限可能为4mm。
