Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, NE9 6SX,UK.
Gynecol Oncol. 2012 Jul;126(1):73-7. doi: 10.1016/j.ygyno.2012.03.041. Epub 2012 Mar 28.
Current surgical treatment of FIGO stage 1B1 cervical cancer is radical surgery. However, several reports have shown that for small tumours a more conservative approach can be as effective in terms of survival, whilst at the same time reducing the morbidity associated with removing the parametrium. The objective of our study was to report survival and obstetric outcomes following conservative management of small-volume stage 1B1 disease.
All patients with FIGO stage 1B1 cancer and estimated tumour volume of less than 500 mm(3) in a loop biopsy specimen were included in the study, irrespective of other histological characteristics. A second loop biopsy was performed to rule out residual disease in 79% of patients.
Sixty two women were identified with a median age of 35 years (range 27-67). Median tumour length was 9.75 mm (7.2-20) and median depth of invasion was 1.55 mm (0.3-5). Thirty five women (56.4%) were treated with loop biopsy, whilst 27 (45.6%) had simple hysterectomy. Fifty seven women (92%) had pelvic lymphadenectomy and one positive node was recorded. After a median follow up of 56 months (16-132) no recurrence was noted. Seven full term pregnancies have been achieved. There were no preterm deliveries or mid-term miscarriages.
Cervical loop biopsy or simple hysterectomy combined with negative pelvic lymphadenectomy for small-volume stage 1B1 cervical cancer offers excellent prognosis in terms of survival. Postoperative morbidity is reduced and obstetric outcomes may be improved. Should these results be verified by further prospective studies, radical surgery for these women may be avoided.
目前 FIGO 分期 1B1 期宫颈癌的手术治疗方法为根治性手术。然而，一些报道表明，对于小肿瘤，可以采用更保守的方法，在生存方面同样有效，同时降低因切除宫旁组织而带来的发病率。本研究的目的是报告小体积 1B1 期疾病采用保守治疗后的生存和产科结局。
所有在环型活检标本中估计肿瘤体积小于 500mm³的 FIGO 分期 1B1 期癌症患者，无论其他组织学特征如何，均纳入本研究。为了排除残留疾病，79%的患者进行了第二次环型活检。
共确定了 62 名年龄中位数为 35 岁（范围 27-67）的女性患者。肿瘤长度中位数为 9.75mm（7.2-20），浸润深度中位数为 1.55mm（0.3-5）。35 名女性（56.4%）接受了环型活检治疗，而 27 名（45.6%）接受了单纯子宫切除术。57 名女性（92%）接受了盆腔淋巴结切除术，记录到 1 个淋巴结阳性。在中位数为 56 个月（16-132）的随访后，未发现复发。有 7 例足月妊娠，无早产或中期流产。
对于小体积 1B1 期宫颈癌，采用宫颈环型活检或单纯子宫切除术联合阴性盆腔淋巴结切除术，在生存方面预后极佳。术后发病率降低，产科结局可能改善。如果这些结果通过进一步的前瞻性研究得到证实，那么这些女性可能可以避免根治性手术。
