Kubota Satoshi, Kobayashi Eiji, Kakuda Mamoru, Matsuzaki Shinya, Ueda Yutaka, Yoshino Kiyoshi, Kimura Tadashi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka, Japan.
J Obstet Gynaecol Res. 2019 Mar;45(3):679-685. doi: 10.1111/jog.13855. Epub 2018 Nov 22.
The use of less radical surgery for early stage cervical cancer has often been discussed. To better determine eligible candidates for less radical surgery, we investigated the risk factors for parametrial involvement (PI).
The study included 193 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer who were treated with radical hysterectomy and pelvic lymphadenectomy between 2008 and 2014. The patients were divided into two groups according to whether or not the parametrium was involved pathologically. The two groups were compared with regards to clinical and histopathological variables.
Univariate analysis showed that International Federation of Gynecology and Obstetrics stage, clinical tumor size, depth of stromal invasion, lymphovascular space invasion and pelvic lymph node metastasis were significantly associated with PI (P < 0.05 each). Multivariate analysis showed pelvic lymph node metastasis was an independent risk factor for PI (odds ratio, 10.70; [95% confidence interval, 3.02-48.08]; P = 0.0006). All patients with clinical tumor size less than or equal to 2 cm and negative for pelvic lymph node metastasis had no PI.
Cervical cancer with the tumor less than or equal to 2 cm and negative for pelvic lymph node metastasis seldom has PI. These patients are good candidates for less radical surgery.
早期宫颈癌采用不太激进的手术方式的应用一直备受讨论。为了更好地确定适合接受不太激进手术的患者，我们调查了宫旁组织受累（PI）的危险因素。
该研究纳入了193例2008年至2014年间接受根治性子宫切除术和盆腔淋巴结清扫术的国际妇产科联盟（FIGO）IB期宫颈癌患者。根据宫旁组织是否存在病理受累将患者分为两组。对两组患者的临床和组织病理学变量进行比较。
单因素分析显示，国际妇产科联盟分期、临床肿瘤大小、间质浸润深度、脉管间隙浸润和盆腔淋巴结转移与PI显著相关（各P < 0.05）。多因素分析显示盆腔淋巴结转移是PI的独立危险因素（比值比，10.70；[95%置信区间，3.02 - 48.08]；P = 0.0006）。所有临床肿瘤大小小于或等于2 cm且盆腔淋巴结转移阴性的患者均无宫旁组织受累。
肿瘤小于或等于2 cm且盆腔淋巴结转移阴性的宫颈癌很少发生宫旁组织受累。这些患者是不太激进手术的合适人选。
