Ditto Antonino, Martinelli Fabio, Bogani Giorgio, Fischetti Margherita, Di Donato Violante, Lorusso Domenica, Raspagliesi Francesco
Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Int J Gynecol Cancer. 2015 Mar;25(3):493-7. doi: 10.1097/IGC.0000000000000371.
The aim of this study was to evaluate the safety, feasibility, and effectiveness of conservative management of early-stage cervical cancer (eCC) in young women willing to preserve their childbearing potential.
Data of 22 consecutive young women (aged <40 years) undergoing conservative management of eCC were prospectively collected. Conservative management consists of cervical conization plus laparoscopic pelvic lymphadenectomy.
Median age was 32.5 years (range, 27-40 years). Twenty-one women (95%) were nulliparous. Histology included adenocarcinoma, squamous cell carcinoma, and adenosquamous carcinoma in 11 (50%), 10 (45%), and 1 (5%) patients, respectively. Six (27%) and 16 patients (73%) were affected by stage IA2 and IB1, respectively. The mean number of pelvic lymph node removed was 26 (SD, 8.6). After primary treatment, 3 patients required radical surgery due to the presence of metastatic nodes detected at the time of diagnostic lymphadenectomy. In addition, 1 patient (5%), after the successful execution of conservative treatment, asked for hysterectomy. After a mean follow-up of 48.8 (SD, 32.8) months, no recurrence was diagnosed among patients undergoing ultraconservative treatment, whereas 2 out of 3 patients with positive pelvic nodes who had radical hysterectomy developed recurrent disease. Considering the whole cohort, 5-year disease-free and overall survival rates were 85.9% and 93.7%, respectively. Looking at reproductive outcomes, 15 of 18 patients (4 patients had hysterectomy) attempted to conceive, and 8 (53%) women had spontaneous pregnancies
Conservative management for eCC seems to be associated with long-term oncologic effectiveness, preserving reproductive function. Further large prospective studies are warranted to improve patients' care.
本研究旨在评估对有保留生育潜力意愿的年轻女性早期宫颈癌（eCC）进行保守治疗的安全性、可行性和有效性。
前瞻性收集了22例连续接受eCC保守治疗的年轻女性（年龄<40岁）的数据。保守治疗包括宫颈锥切术加腹腔镜盆腔淋巴结清扫术。
中位年龄为32.5岁（范围27 - 40岁）。21名女性（95%）未生育。组织学类型包括腺癌、鳞状细胞癌和腺鳞癌，分别有11例（50%）、10例（45%）和1例（5%）患者。分别有6例（27%）和16例（73%）患者为IA2期和IB1期。切除的盆腔淋巴结平均数量为26个（标准差8.6）。初次治疗后，3例患者因诊断性淋巴结清扫时发现有转移淋巴结而需要进行根治性手术。此外，1例患者（5%）在成功完成保守治疗后要求进行子宫切除术。平均随访48.8（标准差32.8）个月后，接受超保守治疗的患者中未诊断出复发，而3例盆腔淋巴结阳性且接受根治性子宫切除术的患者中有2例出现复发性疾病。就整个队列而言，5年无病生存率和总生存率分别为85.9%和93.7%。从生殖结局来看，18例患者中有15例（4例已行子宫切除术）尝试受孕，8例（53%）女性自然受孕。
eCC的保守治疗似乎与长期肿瘤学疗效相关，同时保留了生殖功能。需要进一步开展大型前瞻性研究以改善患者护理。
