Gynaecological Cancer Centre, The Royal Hospital for Women, the School of Women's and Children's Health and the Department of Medicine, Clinical School, University of New South Wales, and the Department of Radiation Oncology, Prince of Wales Hospital, Randwick, the Hunter Area Pathology Service, Faculty of Health Sciences, University of Newcastle, Newcastle, and the National Health and Medical Research Council Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales, Australia.
Obstet Gynecol. 2013 Apr;121(4):765-772. doi: 10.1097/AOG.0b013e3182887836.
To examine the outcome for patients with stage IB2 cervical cancer treated primarily with radical hysterectomy, and to determine the need for adjuvant therapy, the sites of recurrence, and the morbidity of the treatment.
We reviewed our experience with 93 patients with stage IB2 cervical cancer treated with primary surgery at the Royal Hospital for Women in Sydney from 1988 to 2008. All patients underwent radical hysterectomy and pelvic lymphadenectomy. If bulky positive nodes were encountered, they were resected without complete lymphadenectomy. Postoperative radiation was tailored to the histologic findings.
The mean age of the patients was 46 years, and 70% had squamous cell carcinomas. Tumor invaded into the outer third of the cervical stroma in 73 cases (78.5%), occult parametrial extension occurred in 15 cases (16.1%), and vascular space invasion occurred in 65 cases (69.9%). Positive pelvic nodes were present in 42 patients (45.2%) and bulky positive para-aortic nodes were present in 5 patients (5.4%). Some type of postoperative adjuvant (chemoradiation) radiation was given to 74 patients (79.6%). With a median follow-up of 96 months, the overall 5-year survival was 80.7%, being 85% for patients with negative nodes and 75% for those with positive nodes (hazard ratio 2.63, 95% confidence interval 1--5.6; P=.045). The major long-term surgical morbidity was lymphedema, which occurred in eight patients (8.6%). Serious long-term radiation morbidity (Radiation Therapy Oncology Group grade 3) occurred in three patients (3.2%).
Primary radical hysterectomy with tailored postoperative adjuvant radiation for patients with stage IB2 cervical cancer provides good survival with acceptably low morbidity.
III.
研究行根治性子宫切除术治疗的 IB2 期宫颈癌患者的结局，并确定辅助治疗的必要性、复发部位和治疗的发病率。
我们回顾了 1988 年至 2008 年在悉尼皇家妇女医院接受根治性子宫切除术和盆腔淋巴结切除术的 93 例 IB2 期宫颈癌患者的经验。所有患者均行根治性子宫切除术和盆腔淋巴结切除术。如果遇到大的阳性淋巴结，则进行切除，但不进行完全淋巴结切除术。术后放疗根据组织学发现进行调整。
患者的平均年龄为 46 岁，70%为鳞癌。73 例（78.5%）肿瘤侵犯宫颈间质的外三分之一，15 例（16.1%）存在隐匿性宫旁延伸，65 例（69.9%）存在血管间隙浸润。42 例（45.2%）盆腔淋巴结阳性，5 例（5.4%）主动脉旁淋巴结阳性。74 例（79.6%）患者接受了某种类型的术后辅助（放化疗）治疗。中位随访 96 个月后，总体 5 年生存率为 80.7%，淋巴结阴性患者为 85%，淋巴结阳性患者为 75%（风险比 2.63，95%置信区间 1-5.6；P=0.045）。主要的长期手术发病率为淋巴水肿，8 例（8.6%）患者出现该并发症。3 例（3.2%）患者出现严重的长期放射性并发症（放射治疗肿瘤学组 3 级）。
行根治性子宫切除术治疗的 IB2 期宫颈癌患者，术后行辅助放疗，可获得良好的生存率，发病率可接受。
III 级。
