Vanichtantikul A, Tantbirojn P, Manchana T
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Cyto-pathology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Eur J Cancer Care (Engl). 2017 Sep;26(5). doi: 10.1111/ecc.12583. Epub 2016 Oct 5.
This study identified the incidence of parametrial involvement in low risk, early-stage cervical cancer patients and evaluated the factors associated with parametrial involvement. All stage IA2-IB1 cervical cancer patients who underwent radical hysterectomy with pelvic lymphadenectomy were retrospectively reviewed. Patients with squamous cell carcinoma or adenocarcinoma grade 1-2, tumour size less than 2 cm, no lymphovascular space invasion (LVSI), negative pelvic nodes and depth of stromal invasion (DSI) less than 10 mm were identified as the low-risk group. A total of 243 patients were eligible. Squamous cell carcinomas were the most frequent histological cell type (65%). Most patients (81.5%) had tumour size less than 2 cm. Thirteen patients (5.3%) had parametrial involvement, 77 (31.7%) had DSI more than 10 mm, 121 (49.8%) had more than 50% invasion, 119 (49%) had LVSI and 19 (7.5%) had node metastasis. Ninety-five patients (39.1%) were defined as low risk. None of low-risk group had parametrial involvement. DSI more than 10 mm or more than 50% stromal invasion, presence of LVSI and pelvic node metastasis were significant factors associated with parametrial involvement. Parametrial involvement in low-risk, early-stage cervical cancer is extremely low. Less radical surgery may be an alternative treatment option.
本研究确定了低风险早期宫颈癌患者宫旁组织受累的发生率，并评估了与宫旁组织受累相关的因素。对所有接受根治性子宫切除术及盆腔淋巴结清扫术的IA2 - IB1期宫颈癌患者进行回顾性分析。鳞状细胞癌或1 - 2级腺癌、肿瘤大小小于2 cm、无脉管间隙浸润（LVSI）、盆腔淋巴结阴性且间质浸润深度（DSI）小于10 mm的患者被确定为低风险组。共有243例患者符合条件。鳞状细胞癌是最常见的组织学细胞类型（65%）。大多数患者（81.5%）肿瘤大小小于2 cm。13例患者（5.3%）有宫旁组织受累，77例（31.7%）DSI大于10 mm，121例（49.8%）浸润超过50%，119例（49%）有LVSI，19例（7.5%）有淋巴结转移。95例患者（39.1%）被定义为低风险。低风险组中无一例有宫旁组织受累。DSI大于10 mm或间质浸润超过50%、存在LVSI及盆腔淋巴结转移是与宫旁组织受累相关的重要因素。低风险早期宫颈癌的宫旁组织受累极为罕见。手术范围较小的手术可能是一种替代治疗选择。
