Department of Obstetrics and Gynecology, Laboratory Medicine and Pathology, and Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
Obstet Gynecol. 2010 Nov;116(5):1150-7. doi: 10.1097/AOG.0b013e3181f74062.
To estimate the risk of metastatic disease in microinvasive adenocarcinoma of the cervix in a large cohort.
Thirty-six cases were identified from the Mayo Clinic health information database, and 30 cases were identified using the University of Southern California gynecologic oncology patient database. Histopathology was reviewed by a single pathologist at each institution to confirm histologic subtype and grade of tumor, depth of invasion, linear extent of the tumor, the presence or absence of lymphovascular space invasion, margin status, parametrial involvement, and the presence of nodal metastasis.
Fifty-two patients had stage IA1 cancers and 14 had stage IA2 cancers. Therapy ranged from cold knife conization to radical hysterectomy with lymphadenectomy. No parametrial involvement was noted in any of the patients who underwent parametrial resection. One patient with stage IA1 cancer had micrometastasis to a pelvic lymph node. No recurrences were noted with an average follow-up of 80 months.
The management of microinvasive adenocarcinoma remains controversial, and radical therapy is applied more frequently to microinvasive adenocarcinoma than microinvasive squamous cell carcinoma of the cervix. The risk of extracervical disease is low and the risk of recurrence is not affected by the radicality of resection. Our data suggest that microinvasive adenocarcinoma is amenable to treatment with nonradical surgery.
III.
在大型队列中估计宫颈微浸润性腺癌转移疾病的风险。
从梅奥诊所健康信息数据库中确定了 36 例，从南加州大学妇科肿瘤患者数据库中确定了 30 例。每个机构的一名病理学家对组织病理学进行了回顾，以确认组织学亚型和肿瘤分级、浸润深度、肿瘤的线性范围、是否存在血管淋巴管间隙侵犯、切缘状态、宫旁侵犯以及淋巴结转移的存在。
52 例患者为 IA1 期癌症，14 例为 IA2 期癌症。治疗范围从冷刀锥切术到根治性子宫切除术加淋巴结切除术。在接受宫旁切除术的患者中均未发现宫旁侵犯。1 例 IA1 期癌症患者盆腔淋巴结有微转移。平均随访 80 个月后无复发。
微浸润性腺癌的治疗仍存在争议，与宫颈微浸润性鳞癌相比，微浸润性腺癌更常采用根治性治疗。宫颈外疾病的风险较低，切除的根治性不会影响复发的风险。我们的数据表明，微浸润性腺癌适合非根治性手术治疗。
III 级。
