Averette H E, Donato D M, Lovecchio J L, Sevin B U
Department of Obstetrics and Gynecology, University of Miami School of Medicine, Jackson Memorial Medical Center, FL 33101.
Cancer. 1987 Oct 15;60(8 Suppl):2010-20. doi: 10.1002/1097-0142(19901015)60:8+<2010::aid-cncr2820601512>3.0.co;2-y.
The role of surgical staging in gynecologic malignancies has not been precisely defined at this time despite the conventional employment of this modality in the initial staging of ovarian neoplasms. Major discrepancies have been documented between clinical and surgical estimates of disease extent in cervical, endometrial, and vulvar carcinomas. We recently reviewed our experience with patients who were found to have positive periaortic nodes after surgical exploration for clinical Stage IB and Stage IIA cervical cancer. Postoperative extended field radiotherapy was employed with minimum complications and the 5-year actuarial survival rate was 50% with a median survival time of 29 months. In order to justify the utilization of surgical staging for gynecologic neoplasms, it is necessary to demonstrate a survival advantage in patients where the precise extent of disease has been established and subsequent therapy tailored accordingly. In addition, it must be shown that surgical staging does not increase complications or decrease the efficacy of subsequent therapeutic interventions.
尽管手术分期在卵巢肿瘤的初始分期中已常规应用，但目前其在妇科恶性肿瘤中的作用尚未得到精确界定。在宫颈癌、子宫内膜癌和外阴癌的疾病范围临床评估与手术评估之间，已记录到重大差异。我们最近回顾了因临床ⅠB期和ⅡA期宫颈癌接受手术探查后发现腹主动脉旁淋巴结阳性患者的治疗经验。采用术后扩大野放疗，并发症最少，5年精算生存率为50%，中位生存时间为29个月。为了证明手术分期在妇科肿瘤中的应用合理性，有必要证明在已确定疾病确切范围并据此调整后续治疗的患者中存在生存优势。此外，必须表明手术分期不会增加并发症或降低后续治疗干预的疗效。
