Yoshinaga Mitsuhiro, Hamada Tomonori, Orita Yuji, Yoshitomi Shintomo Nao, Matsuo Takashi, Tsuji Takahiro, Tabata Kazuhiro, Douchi Tsutomu
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
J Obstet Gynaecol Res. 2011 Nov;37(11):1645-9. doi: 10.1111/j.1447-0756.2011.01590.x. Epub 2011 Jul 25.
The present study investigated the clinical outcome of stage Ia1 squamous cell carcinoma (SCC) of the uterine cervix at a single institute.
Subjects were 84 patients with cervical SCC, International Federation of Gynecology and Obstetrics stage Ia1 diagnosed according to conization findings between January 2000 and June 2009. Correlations between clinical outcome and pathological findings on initial conization were investigated.
Of 65 hysterectomy (without pelvic lymphadenectomy) patients, two (3.1%) showed metastasis to the vaginal wall, and two (3.1%) to the pelvic lymph nodes. Five patients (6.0%) showed lymphovascular invasion, and three (3.6%) showed confluent patterns of stromal invasion (confluent invasion) on initial conization findings. All of these five patients were included in the hysterectomy group. Of 19 patients with conization alone, two showed vaginal metastasis. Of four patients with vaginal metastasis, two showed lymphovascular invasion and one showed confluent invasion despite negative conization margin. In patients with nodal metastasis, stromal invasion of 3.0 mm and 2.8 mm, and horizontal spread of 6.8 mm and 6.9 mm were observed on conization, respectively. All patients are currently alive due to adequa\e therapy including chemo-radiation for six patients with recurrent disease.
In patients showing stromal invasion of nearly 3.0 mm and horizontal spread of nearly 7.0 mm in stage Ia1 cervical SCC, pelvic lymphadenectomy may be considered. Even for patients showing a negative conization margin, careful follow up is necessary, because vaginal metastasis sometimes occurs.
本研究在单一机构调查子宫颈Ia1期鳞状细胞癌（SCC）的临床结局。
研究对象为84例宫颈SCC患者，根据2000年1月至2009年6月间锥切结果诊断为国际妇产科联盟（FIGO）Ia1期。研究初始锥切时临床结局与病理结果之间的相关性。
在65例行子宫切除术（未行盆腔淋巴结清扫术）的患者中，2例（3.1%）出现阴道壁转移，2例（3.1%）出现盆腔淋巴结转移。5例（6.0%）出现脉管浸润，3例（3.6%）在初始锥切结果中显示间质浸润融合模式（融合浸润）。这5例患者均纳入子宫切除组。在19例仅行锥切术的患者中，2例出现阴道转移。在4例发生阴道转移的患者中，2例出现脉管浸润，1例尽管锥切切缘阴性仍出现融合浸润。在发生淋巴结转移的患者中，锥切时分别观察到间质浸润深度为3.0mm和2.8mm，水平扩散为6.8mm和6.9mm。所有患者目前均存活，6例复发患者接受了包括放化疗在内的充分治疗。
对于Ia1期宫颈SCC患者，若间质浸润近3.0mm且水平扩散近7.0mm，可考虑行盆腔淋巴结清扫术。即使锥切切缘阴性的患者也需要密切随访，因为有时会发生阴道转移。
