Gynaecologic Oncology Unit, Azienda Ospedaliera Bolognini, Seriate, Italy.
Gynecol Oncol. 2011 Dec;123(3):557-60. doi: 10.1016/j.ygyno.2011.08.009. Epub 2011 Sep 9.
Simple conization represents a plausible treatment scheme for managing stage IA1-2 tumors conservatively. However its curative potential has not been widely exploited as regards stage IB1 lesions. Recent studies suggest that, in selected circumstances, patients with stage IB1 disease undergoing radical hysterectomy could have been safely cured by simple hysterectomy and even by cervical conization.
Patients with stage IB1 cervical cancer desiring conservative management underwent simple conization and pelvic lymphadenectomy in three Italian institutes.
Thirty-six women received the conservative treatment since 1995 to 2010. Median age was 31 (range 24-40) years and median tumor size was 11.7 mm (range 8-25 mm). Adenocarcinoma was present in 12 cases (33%) and grade 3 neoplasia in 5 (14%). Lymph-vascular space involvement was detected in five patients (14%). Eleven had already a child while two had experienced an early abortion and a fetal loss at second trimester. After a median follow-up of 66 months (range 6-168) only one pelvic lymphnodal relapse was observed. Twenty-one pregnancies occurred in 17 patients and 14 live babies have been born (two preterm at 27 and 32 weeks) while one is ongoing. Three first-trimester miscarriages, one second-trimester fetal loss, an ectopic pregnancy and a termination of pregnancy have been recorded. Five patients decided to undergo hysterectomy after 3-12 years after conservative therapy: in one residual microinvasive adenocarcinoma was found.
Cervical conization represents a feasible conservative management of stage IB1 cervical cancer and shows a low risk of relapse, provided that patients are selected carefully. Conization would be suitable to treat stage IB lesions smaller than 15-20mm. with pathologic negative lymphnodes.
单纯锥切术代表了一种可行的治疗方案，可保守治疗 IA1-2 期肿瘤。然而，对于 IB1 期病变，其治疗潜力尚未得到广泛利用。最近的研究表明，在某些情况下，接受根治性子宫切除术的 IB1 期疾病患者可以通过单纯子宫切除术甚至宫颈锥切术安全治愈。
在意大利的三个研究所中，患有 IB1 期宫颈癌并希望进行保守治疗的患者接受了单纯锥切术和盆腔淋巴结切除术。
自 1995 年至 2010 年，共有 36 名女性接受了保守治疗。中位年龄为 31 岁（范围 24-40 岁），中位肿瘤大小为 11.7 毫米（范围 8-25 毫米）。12 例（33%）为腺癌，5 例（14%）为 3 级肿瘤。5 例患者存在淋巴管血管间隙浸润。11 例患者已有孩子，2 例患者经历了早期流产和孕中期胎儿丢失。中位随访时间为 66 个月（范围 6-168），仅观察到 1 例盆腔淋巴结复发。17 例患者中有 21 例发生妊娠，14 例活产（2 例早产，分别为 27 周和 32 周），1 例仍在继续妊娠。记录了 3 例早期流产、1 例孕中期胎儿丢失、1 例异位妊娠和 1 例终止妊娠。5 例患者在保守治疗后 3-12 年决定行子宫切除术：其中 1 例发现残留微小浸润性腺癌。
宫颈锥切术是治疗 IB1 期宫颈癌的一种可行的保守治疗方法，复发风险较低，但前提是患者要经过仔细选择。对于病理淋巴结阴性、肿瘤小于 15-20mm 的 IB1 期病变，锥切术可能是一种合适的治疗方法。
