He Yue, Wu Yu-Mei, Zhao Qun, Wang Tong, Wang Yan, Kong Wei-Min, Song Fang, Duan Wei, Zhu Li, Zhang Wei-Yuan
Departments of *Gynecologic Oncology, †Pathology, and ‡Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Int J Gynecol Cancer. 2014 Sep;24(7):1306-11. doi: 10.1097/IGC.0000000000000199.
The aim of the study is to evaluate the clinical value of cold knife conization (CKC) as a conservative management in patients with microinvasive cervical squamous cell cancer (SCC).
This retrospective study enrolled 108 women with diagnosis of microinvasive cervical SCC (stage IA1) by pathology between 2009 to 2012 at Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Eighty-three patients underwent further hysterectomy.
Of the 83 patients (76.9%) who underwent further hysterectomy, 48 patients (57.8%) underwent extrafascial hysterectomy, 30 patients (36.1%) underwent extensive hysterectomy, and 5 patients (6.1%) underwent radical hysterectomy. A total of 19 patients underwent pelvic lymph node dissection without any lymph node metastasis, and a total of 5 patients (4.6%) had lymph vascular space invasion without any positive pelvic lymph node dissection. Of the 83 patients who underwent further hysterectomy and were followed up for 1 year, 18 patients with positive resection margins indicating cervical residual lesions (CIN1-3) have greater likelihood than 65 patients with clear resection margins, but there were no significant differences (P = 0.917); of the 25 patients who underwent CKC as final therapy and were followed up for 1 year, 2 patients with positive resection margins had the second CKC surgery, 1 was diagnosed with CIN1, and the other was diagnosed with cervicitis by pathology; 23 patients had clear resection margins, 2 patients underwent the second CKC 3 months after the first CKC because of the abnormal Thinprep Cytologic Test (TCT) result, and they were both diagnosed with microinvasive cervical SCC (stage IA1) by pathology with clear resection margins. No one enrolled in this study presented metastasis and progression within 1 year of follow-up.
These findings provide the clinical evidences for the possibility of fertility-sparing treatments, especially CKC as conservative treatment for microinvasive cervical SCC. Appropriate further treatments (the second CKC) and follow-up are recommended for patients who strongly desire fertility sparing.
本研究旨在评估冷刀锥切术（CKC）作为微浸润性宫颈鳞状细胞癌（SCC）患者保守治疗方法的临床价值。
这项回顾性研究纳入了2009年至2012年期间在北京妇产医院、首都医科大学经病理诊断为微浸润性宫颈SCC（IA1期）的108名女性。83名患者接受了进一步的子宫切除术。
在接受进一步子宫切除术的83名患者（76.9%）中，48名患者（57.8%）接受了筋膜外子宫切除术，30名患者（36.1%）接受了广泛性子宫切除术，5名患者（6.1%）接受了根治性子宫切除术。共有19名患者接受了盆腔淋巴结清扫，无淋巴结转移，共有5名患者（4.6%）有淋巴血管间隙浸润，盆腔淋巴结清扫均为阴性。在接受进一步子宫切除术并随访1年的83名患者中，18名切缘阳性提示宫颈残留病变（CIN1 - 3）的患者比65名切缘清晰的患者复发可能性更大，但差异无统计学意义（P = 0.917）；在25名接受CKC作为最终治疗并随访1年的患者中，2名切缘阳性的患者接受了第二次CKC手术，1名病理诊断为CIN1，另1名诊断为宫颈炎；23名患者切缘清晰，2名患者因薄层液基细胞学检测（TCT）结果异常在首次CKC术后3个月接受了第二次CKC手术，病理均诊断为微浸润性宫颈SCC（IA1期），切缘清晰。本研究中纳入的患者在随访1年内均未出现转移和进展。
这些研究结果为保留生育功能治疗的可能性提供了临床证据，尤其是CKC作为微浸润性宫颈SCC的保守治疗方法。对于强烈希望保留生育功能的患者，建议进行适当的进一步治疗（第二次CKC）和随访。
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