Division of Obstetrics and Gynecology, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan.
Int J Gynecol Cancer. 2010 Aug;20(6):1063-6. doi: 10.1111/IGC.0b013e3181e768b6.
The adenocarcinoma of the uterine cervix tends to arise in women of childbearing age. Conservative treatment by conization is an alternative to a hysterectomy that allows future pregnancy; however, much less is known about the management of adenocarcinoma because of its rarity and relatively short time frame of follow-up. The purpose of this study was to determine the long-term outcome of patients treated by conization alone.
All patients diagnosed to have FIGO (International Federation of Gynecology and Obstetrics) stage IA1 cervical adenocarcinoma between 1990 and 2004 with more than 5 years' follow-up at 2 institutions were reviewed. Information was abstracted on clinical data including margin status of conization and recurrence.
Twenty-seven patients were identified, and 10 patients who expressed a strong desire to preserve fertility were offered a conization and careful surveillance without hysterectomy. The median age was 35 years, and 40% were nulliparous. All tumors were endocervical-type adenocarcinoma, and all tumors were grade 1. None had lymphovascular space invasion. Two patients had a repeated conization because of a positive margin. No recurrence was observed during an average follow-up of 75 months.
Although further studies on the management of microinvasive cervical adenocarcinoma are desirable, conization seems to be acceptable treatment modality for patients with stage IA1 cervical adenocarcinoma who desire to preserve their fertility. A careful and long-term follow-up is needed because of lack of sufficient evidence for the safety of this treatment.
子宫颈腺癌倾向于发生在育龄妇女中。宫颈锥切术的保守治疗是子宫切除术的一种替代方法，可允许未来妊娠；然而，由于其罕见性和相对较短的随访时间，对于腺癌的治疗知之甚少。本研究的目的是确定单独接受锥切术治疗的患者的长期预后。
回顾了在两个机构诊断为 FIGO（国际妇产科联合会）IA1 期宫颈癌且随访时间超过 5 年的所有患者。摘要了包括锥切边缘状态和复发在内的临床数据信息。
共确定了 27 例患者，有 10 例强烈希望保留生育能力的患者接受了锥切术和仔细的监测，而未进行子宫切除术。中位年龄为 35 岁，40%为未产妇。所有肿瘤均为宫颈内膜型腺癌，且均为 1 级。无一例有淋巴血管间隙浸润。由于边缘阳性，有 2 例患者再次接受了锥切术。在平均 75 个月的随访中未观察到复发。
尽管进一步研究微浸润性宫颈癌的治疗方法是可取的，但对于希望保留生育能力的 IA1 期宫颈癌患者，锥切术似乎是可接受的治疗方法。由于缺乏这种治疗方法安全性的充分证据，需要进行仔细和长期的随访。
