Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
Gynecol Oncol. 2011 Dec;123(3):577-80. doi: 10.1016/j.ygyno.2011.08.024. Epub 2011 Sep 25.
Cancer staging systems should be responsive to the development of diagnostic tools. The International Federation of Gynecology and Obstetrics (FIGO) cervical cancer guidelines were modified in 2009 regarding the pretreatment assessment. We report the recent Japanese patterns of pretreatment workup for cervical cancer.
The Japanese Patterns of Care Study (PCS) working group analyzed the pretreatment diagnostic assessment data of 609 patients with cervical cancer treated with definitive radiotherapy in the two survey periods (1999-2001, 324; 2003-2005, 285) in Japan. Sixty-one of 640 institutions were selected for this survey using a stratified two-staged cluster sampling method.
The use of optional examinations in the latest FIGO guidelines such as intravenous urography, cystoscopy, and proctoscopy was gradually decreasing. Surgical staging was rarely performed in either survey period. Computed tomography (CT) and magnetic resonance imaging (MRI) were widely used, and MRI has become increasingly prevalent even between the two survey periods. Primary lesion size and pelvic lymph node status was evaluated by CT/MRI for most patients in both surveys.
The use of CT/MRI that is encouraged in the latest FIGO staging guidelines already replaced intravenous urography, cystoscopy, and proctoscopy in Japan. Japanese patients received the potential benefit of CT/MRI because prognostic factors such as primary lesion size and pelvic lymph node status were evaluated by these modalities. The use of cystoscopy and proctoscopy should be continuously monitored in the future PCS survey because only CT/MRI could lead to the stage migration for patients on suspicion of bladder/rectum involvement on CT/MRI.
癌症分期系统应能反映诊断工具的发展情况。国际妇产科联合会（FIGO）于 2009 年对宫颈癌治疗前评估标准进行了修订。我们报告了最近日本宫颈癌治疗前检查的模式。
日本肿瘤治疗结果研究组（PCS）分析了 1999-2001 年（324 例）和 2003-2005 年（285 例）两个时期接受根治性放疗的 609 例宫颈癌患者的治疗前诊断评估数据。采用分层两阶段整群抽样方法，从 640 个机构中选择了 61 个机构进行本调查。
最新 FIGO 指南中推荐的可选检查（静脉尿路造影、膀胱镜和直肠镜检查）的应用逐渐减少。两个调查期间均很少进行外科分期。计算机断层扫描（CT）和磁共振成像（MRI）广泛应用，MRI 的应用甚至在两个调查期间也逐渐增多。大多数患者的原发肿瘤大小和盆腔淋巴结状态均通过 CT/MRI 评估。
最新 FIGO 分期指南中推荐的 CT/MRI 的使用已经取代了静脉尿路造影、膀胱镜和直肠镜检查。由于 CT/MRI 可评估预后因素，如原发肿瘤大小和盆腔淋巴结状态，因此日本患者从中受益。未来的 PCS 调查中应持续监测膀胱镜和直肠镜的使用，因为仅 CT/MRI 可能会导致对 CT/MRI 怀疑有膀胱/直肠受累的患者发生分期迁移。
