Póka Robert, Molnár Szabolcs, Daragó Péter, Lukács János, Lampé Rudolf, Krasznai Zoárd, Hernádi Zoltán
Unit of Gynecological Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Int J Gynecol Cancer. 2017 Sep;27(7):1438-1445. doi: 10.1097/IGC.0000000000001048.
The aim of our study was to evaluate clinical and pathological data in order to draw eligibility criteria for oncologically sufficient radical trachelectomy (RT) in early-stage cervical cancer. Reviewing all cases of attempted RT performed at our unit, we focused attention on prognostic indicators of the need for additional oncologic treatment following RT. The analysis was extended by extensive literature review to include previously published cases of oncologic failures.
The authors retrospectively analyzed data of patients who underwent RT at the Department of Obstetrics and Gynecology, University of Debrecen. Electronic records and case notes of RT cases were reviewed to determine the incidence of abdominal and vaginal route, distribution of clinicopathologic data, and follow-up results of individual cases. Individual procedures were categorized as oncologically insufficient if additional oncologic treatment was necessary following RT. Theoretical eligibility criteria for RT in early-stage cervical cancer were determined retrospectively by selecting prognostic features that were associated with oncologic insufficiency from clinicopathologic indicators of the complete series.
Twenty-four cases of RT were performed by the authors, 15 vaginal RTs with laparoscopic pelvic lymphadenectomy and 9 abdominal RTs with open pelvic lymphadenectomy. Fifteen of 24 cases proved oncologically sufficient. Three cases required immediate conversion to radical hysterectomy because of positive sentinel nodes and/or positive isthmic disc on frozen section. In further 5 cases, final pathology results indicated additional oncologic treatment, that is, radical hysterectomy (n = 2), chemoradiotherapy (n = 2), or chemotherapy (n = 1). One patient among immediately converted cases and another 3 among those who required additional oncologic treatment died of their disease later. There were no other cases of recurrences over a median follow-up of 34 months (range, 12-188 months). Factors that may predict oncologic insufficiency of RT were stage IB1 or greater, tumor size of greater than 2 cm in 1 dimension or greater than 15 mm in 3 dimensions, G3, nonsquamous/adeno histological type, stromal invasion of greater than 9 mm, and lymphovascular space involvement in the primary tumor.
Most cases of oncologically insufficient RTs have significant risk features that can be identified preoperatively. There is a need for more clinicopathologic data on oncologic failure of RT cases in order to improve patient selection.
本研究旨在评估临床和病理数据，以制定早期宫颈癌根治性气管切除术（RT）的合适标准。回顾在本单位进行的所有RT尝试病例，我们关注RT后需要额外肿瘤治疗的预后指标。通过广泛的文献综述扩展分析，纳入先前发表的肿瘤治疗失败病例。
作者回顾性分析了德布勒森大学妇产科接受RT的患者数据。查阅RT病例的电子记录和病历，以确定腹部和阴道途径的发生率、临床病理数据分布以及个别病例的随访结果。如果RT后需要额外的肿瘤治疗，则将个别手术归类为肿瘤学上不足。通过从完整系列的临床病理指标中选择与肿瘤学不足相关的预后特征，回顾性确定早期宫颈癌RT的理论合适标准。
作者进行了24例RT，15例为阴道RT加腹腔镜盆腔淋巴结清扫术，9例为腹部RT加开放性盆腔淋巴结清扫术。24例中有15例在肿瘤学上足够。3例因前哨淋巴结阳性和/或冰冻切片时峡部切片阳性而需要立即转为根治性子宫切除术。在另外5例中，最终病理结果表明需要额外的肿瘤治疗，即根治性子宫切除术（n = 2）、放化疗（n = 2）或化疗（n = 1）。立即转为根治性子宫切除术的患者中有1例，以及需要额外肿瘤治疗的患者中有3例后来死于疾病。在中位随访34个月（范围12 - 188个月）期间，没有其他复发病例。可能预测RT肿瘤学不足的因素为IB1期或更高分期、一维肿瘤大小大于2 cm或三维肿瘤大小大于15 mm、G3、非鳞状/腺癌组织学类型、间质浸润大于9 mm以及原发肿瘤的脉管间隙受累。
大多数肿瘤学上不足的RT病例具有术前可识别的显著风险特征。需要更多关于RT病例肿瘤治疗失败的临床病理数据，以改善患者选择。
