Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Rome, Italy.
Int J Gynecol Cancer. 2021 Mar;31(3):452-456. doi: 10.1136/ijgc-2020-001750.
Conization/simple trachelectomy is feasible in patients with early-stage cervical cancer. Retrospective data suggest that conization with negative lymph nodes could be a safe option for these patients. This study aims to provide oncologic and obstetric outcomes of a large series of patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer managed by conization.
Patients with early cervical cancer and a desire to preserve fertility who underwent conization and pelvic lymphadenectomy from January 1993 to December 2019 in two Italian centers were included. Inclusion criteria were: age >18 years and ≤45 years, 2018 FIGO stage IB1, no prior irradiation or chemotherapy, absence of pre-operative radiologic evidence of nodal metastases, a strong desire to preserve fertility, and absence of concomitant malignancies. We excluded patients with confirmed infertility, neuroendocrine tumor, clear cell or mucinous carcinoma.
A total of 42 patients were included. The median age was 32 years (range 19-44) and median tumor size was 11 mm (range 8-20). Squamous cell carcinoma was found in 27 (64.3%). Grade 3 tumor was present in 7 (16.7%) patients and lymphovascular space involvement was detected in 15 (35.7%). At a median follow-up of 54 months (range 1-185), all patients were alive without evidence of disease. In the entire series three patients experienced recurrence resulting in an overall recurrence rate of 7.1%. All the recurrences occurred in the pelvis (2 in the cervix and 1 in the lymph nodes), resulting in a 3-year disease-free survival of 91.6%. Twenty-two (52%) patients tried to conceive; 18 pregnancies occurred in 17 patients and 12 live births were reported (6 pre-term and 6 term pregnancies). Two miscarriages were recorded, one first trimester and one second trimester fetal loss.
Our study showed that conization is feasible for the conservative management of women with stage IB1 cervical cancer desiring fertility. Oncologic outcomes appear favorable in this series of patients. Future prospective studies will hopefully provide further insight into this important question.
锥形切除术/单纯子宫颈管切除术在早期宫颈癌患者中是可行的。回顾性数据表明，对于这些患者，淋巴结阴性的锥形切除术可能是一种安全的选择。本研究旨在提供大量 2018 年国际妇产科联合会（FIGO）分期为 IB1 期宫颈癌患者接受锥形切除术和盆腔淋巴结切除术的肿瘤学和产科结局。
纳入 1993 年 1 月至 2019 年 12 月在意大利的两个中心因早期宫颈癌且希望保留生育能力而行锥形切除术和盆腔淋巴结切除术的患者。纳入标准为：年龄>18 岁且≤45 岁，2018 年 FIGO 分期 IB1 期，无术前影像学证据提示淋巴结转移，强烈希望保留生育能力，无同时性恶性肿瘤。我们排除了确诊为不孕、神经内分泌肿瘤、透明细胞癌或黏液癌的患者。
共纳入 42 例患者。中位年龄为 32 岁（范围 19-44），中位肿瘤大小为 11mm（范围 8-20）。27 例（64.3%）为鳞状细胞癌。7 例（16.7%）患者为 3 级肿瘤，15 例（35.7%）患者存在脉管间隙浸润。中位随访时间为 54 个月（范围 1-185），所有患者均存活且无疾病证据。在整个系列中，有 3 例患者复发，总复发率为 7.1%。所有复发均发生在盆腔（2 例在宫颈，1 例在淋巴结），导致 3 年无病生存率为 91.6%。22 例（52%）患者尝试妊娠；17 例患者发生 18 例妊娠，报告了 12 例活产（6 例早产，6 例足月妊娠）。记录到 2 例流产，1 例发生在早期妊娠，1 例发生在中期妊娠。
我们的研究表明，锥形切除术可用于有生育需求的 IB1 期宫颈癌患者的保守治疗。在本系列患者中，肿瘤学结局似乎良好。未来的前瞻性研究有望进一步深入探讨这一重要问题。
