Frumovitz Michael, Sun Charlotte C, Schmeler Kathleen M, Deavers Michael T, Dos Reis Ricardo, Levenback Charles F, Ramirez Pedro T
From the Departments of Gynecologic Oncology and Pathology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas; and the Gynecologic Oncology Service, Hospital de Clinicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos 2350, Porto Alegre, Brazil.
Obstet Gynecol. 2009 Jul;114(1):93-99. doi: 10.1097/AOG.0b013e3181ab474d.
To estimate the incidence of parametrial involvement and to evaluate factors associated with parametrial spread in women with early-stage cervical cancer and to identify a cohort of patients at low risk for parametrial spread who may benefit from less radical surgery.
We reviewed all patients who underwent radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer between 1990 and 2006. All women with squamous, adenocarcinoma, or adenosquamous disease, stage IA2-IB1, who underwent completed radical hysterectomy were included in the analysis. Normally distributed continuous variables were compared using Student's t-test for independent samples to analyze the outcome of positive or negative parametrial involvement.
Three hundred fifty patients met the inclusion criteria. Overall, 27 women (7.7%) had parametrial involvement. The majority of specimens with parametrial involvement (52%) had tumor spread through direct microscopic extension. Patients with parametrial involvement were more likely to have a primary tumor size larger than 2 cm (larger than 2 cm: 14%, smaller than 2 cm: 4%, P=.001), higher histologic grade (grade 3: 12%, grades 1 and 2: 3%, P=.01), lymphovascular space invasion (positive: 12%, negative: 3%, P=.002), and metastasis to the pelvic lymph nodes (positive: 31%, negative: 4%, P<.001). One hundred twenty-five women (36%) had squamous, adenocarcinoma, or adenosquamous lesions, all grades, with primary tumor size 2 cm or smaller and no lymphovascular space invasion. In this group of patients, there was no pathologic evidence of parametrial involvement.
We were able to retrospectively identify a cohort of women with early-stage cervical cancer who were at very low risk for parametrial involvement. If prospective application of these findings confirms our results, less radical surgery-such as simple hysterectomy, simple trachelectomy, or conization-with pelvic lymphadenectomy may be a reasonable therapeutic option for women with primary tumors 2 cm or smaller and no lymphovascular space invasion.
III.
评估早期宫颈癌患者宫旁组织受累的发生率，评价与宫旁组织扩散相关的因素，并确定一组宫旁组织扩散低风险患者，这些患者可能从较不根治性的手术中获益。
我们回顾了1990年至2006年间所有因浸润性宫颈癌接受根治性子宫切除术和盆腔淋巴结清扫术的患者。所有IA2 - IB1期的鳞状细胞癌、腺癌或腺鳞癌患者，若接受了完整的根治性子宫切除术，则纳入分析。使用独立样本的Student t检验比较正态分布的连续变量，以分析宫旁组织受累阳性或阴性的结果。
350例患者符合纳入标准。总体而言，27例女性（7.7%）有宫旁组织受累。大多数宫旁组织受累的标本（52%）肿瘤通过直接显微镜下扩展扩散。宫旁组织受累的患者更可能有原发肿瘤大小大于2 cm（大于2 cm：14%，小于2 cm：4%，P = 0.001）、更高的组织学分级（3级：12%，1级和2级：3%，P = 0.01）、淋巴管间隙浸润（阳性：12%，阴性：3%，P = 0.002）以及盆腔淋巴结转移（阳性：31%，阴性：4%，P < 0.001）。125例女性（36%）有鳞状细胞癌、腺癌或腺鳞癌病变，所有分级均有，原发肿瘤大小为2 cm或更小且无淋巴管间隙浸润。在这组患者中，没有宫旁组织受累的病理证据。
我们能够回顾性地确定一组早期宫颈癌患者，其宫旁组织受累风险极低。如果这些发现的前瞻性应用证实了我们的结果，那么对于原发肿瘤大小为2 cm或更小且无淋巴管间隙浸润的女性，较不根治性的手术，如单纯子宫切除术、单纯宫颈切除术或锥切术加盆腔淋巴结清扫术，可能是一种合理的治疗选择。
III级。
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