Murakami Isao, Ohno Akiko, Ikeda Masae, Yamashita Hiroshi, Mikami Mikio, Kobayashi Yoichi, Nagase Satoru, Yokoyama Masatoshi, Enomoto Takayuki, Katabuchi Hidetaka
Department of Obstetrics and Gynecology, National Hospital Organization Tokyo Medical Center, Japan.
Department of Obstetrics and Gynecology, Toho University Ohashi Medical Center, Japan.
Heliyon. 2020 Oct 8;6(10):e05193. doi: 10.1016/j.heliyon.2020.e05193. eCollection 2020 Oct.
With increased screening, more patients with precancerous or early cervical cancer are now being identified. Age at pregnancy, and thus number of patients requiring fertility preservation, have also increased, resulting in more diagnostic and therapeutic cervical conization (conization) procedures. We here investigated the pathological and clinical characteristics of patients undergoing conization, with a focus on age. The objectives of our study were to identify the risk factors potentially involved in cervical intraepithelial neoplasia (CIN) recurrence or persistence, additional treatment after conization, the effects of conization on pregnancy, and the actual status of conization in Japan.
A "Subcommittee for Investigation of Cervical Conization" within the Gynecologic Oncology Committee in the Japan Society of Obstetrics and Gynecology investigated pathological and clinical characteristics of conization at 205 institutions in Japan. We analyzed pathological and clinical characteristics according to age ≤50 and >50 years.
Patients aged 20-40 years accounted for 12904 (87%) of the 14,832 study patients (median: 37 years, range: 16-88 years). However, 1838 (12.4%) were aged >50 years. The commonest post-operative diagnosis was CIN grade 3 in all age groups. Rates of invasive cancer, post-operative detection of more advanced lesions, positive surgical margins, additional treatment, and recurrence were significantly higher in patients aged ≥50 years than those aged <50 years (all p < 0.01), whereas rates of post-operative complications did not differ significantly between age groups. The relationship between cerclage and the incidence of amniorrhexis or premature birth did not differ significantly in any age group.
Post-conization management of patients aged ≥50 years requires considering the high rates of detection of more advanced lesions post-operatively, positive surgical margins, and recurrence. Cerclage should not be performed post-conization without careful consideration.
随着筛查的增加，现在发现了更多的癌前或早期宫颈癌患者。妊娠年龄以及因此需要保留生育能力的患者数量也有所增加，导致更多的诊断性和治疗性宫颈锥切术（锥切术）。我们在此研究了接受锥切术患者的病理和临床特征，重点关注年龄。我们研究的目的是确定可能与宫颈上皮内瘤变（CIN）复发或持续、锥切术后额外治疗、锥切术对妊娠的影响以及日本锥切术的实际情况相关的危险因素。
日本妇产科学会妇科肿瘤委员会内的“宫颈锥切术调查小组委员会”调查了日本205家机构的锥切术病理和临床特征。我们根据年龄≤50岁和>50岁分析了病理和临床特征。
在14832例研究患者中，20至40岁的患者有12904例（87%）（中位数：37岁，范围：16至88岁）。然而，1838例（12.4%）年龄>50岁。所有年龄组最常见的术后诊断为CIN 3级。≥50岁患者的浸润癌、术后检测到更高级别病变、手术切缘阳性、额外治疗和复发率显著高于<50岁患者（所有p<0.01），而年龄组之间术后并发症发生率无显著差异。宫颈环扎术与胎膜早破或早产发生率之间的关系在任何年龄组中均无显著差异。
≥50岁患者的锥切术后管理需要考虑术后检测到更高级别病变、手术切缘阳性和复发的高发生率。未经仔细考虑，不应在锥切术后进行宫颈环扎术。
