Papakonstantinou Katerina, Kyrgiou Maria, Lyons Deidre, Soutter William P, Ghaem-Maghami Sadaf
West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, England, UK.
West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, England, UK; Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, England, UK.
Am J Obstet Gynecol. 2014 Dec;211(6):625.e1-6. doi: 10.1016/j.ajog.2014.06.032. Epub 2014 Jun 17.
The aim of this study was to assess the effect of the excision margin after cone for stage Ia1 cervical cancer on long-term outcomes.
Retrospective observational study. Patients were divided into 3 groups. Group A underwent immediate reflex hysterectomy; group B had cervical intraepithelial neoplasia (CIN) at the margins but were followed up; group C had clear margins.
We identified 111 women: 19 (17.1%) in group A; 29 (26.1%) in group B; and 63 (56.8%) in group C. Women in group A were older (median, 40 years vs 35 years; P = .0001) with higher rate of endocervical margin involvement (89.5 vs 48.1%, P = .007) than in group B. The women had been followed for a total of 960 woman-years with median follow-up of 398 weeks (quartiles: 258,612). Women with clear margins in the initial excision were more likely to remain free of disease than those with involved (P < .0001). Further surgery was required due to abnormal cytology in 9 (31.0%) women from group B and 7 (11.1%) from group C (P = .04). The cumulative rate of recurrent CIN2+ was 6.4% in group B and 2.7% in group C (P = .17). In group B, recurrences were more common in positive endocervical rather than ectocervical margins (66.6% vs 33.4%, P < .05); all had high-grade CIN at the margins.
The risk of posttreatment CIN2+ is substantially reduced when complete excision is achieved at first treatment. Conservative management is contraindicated in women with microinvasion at the margin. When CIN involves the margin, there is a greater risk of residual disease and of further treatment.
本研究旨在评估Ia1期宫颈癌锥形切除术后切缘对长期预后的影响。
回顾性观察研究。患者分为3组。A组接受即刻根治性子宫切除术；B组切缘有宫颈上皮内瘤变（CIN）但进行随访；C组切缘阴性。
我们纳入了111名女性：A组19名（17.1%）；B组29名（26.1%）；C组63名（56.8%）。A组女性年龄更大（中位年龄40岁对35岁；P = 0.0001），宫颈管切缘受累率更高（89.5%对48.1%，P = 0.007）。这些女性共随访了960人年，中位随访时间为398周（四分位数：258,612）。初始切除切缘阴性的女性比切缘受累的女性更有可能无疾病复发（P < 0.0001）。B组9名（31.0%）女性和C组7名（11.1%）女性因细胞学异常需要进一步手术（P = 0.04）。B组CIN2+复发累积率为6.4%，C组为2.7%（P = 0.17）。在B组中，宫颈管切缘阳性的复发比宫颈外口切缘阳性更常见（66.6%对33.4%，P < 0.05）；所有切缘均为高级别CIN。
首次治疗时实现完全切除可显著降低治疗后CIN2+的风险。切缘有微浸润的女性禁忌保守治疗。当CIN累及切缘时，残留疾病和进一步治疗的风险更大。
