锥形切除术和淋巴结评估作为早期宫颈癌的保留生育力治疗。
Conization and lymph node evaluation as a fertility-sparing treatment for early stage cervical cancer.
机构信息
Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
出版信息
Int J Gynecol Cancer. 2021 Mar;31(3):457-461. doi: 10.1136/ijgc-2020-001740.
INTRODUCTION
To evaluate oncological and obstetrical outcomes of early stage cervical cancer patients who underwent conservative management to retain childbearing potential.
METHODS
Data of women (aged <40 years) who underwent fertility sparing treatment for International Federation of Gynecology and Obstetrics (FIGO) stage IA1 with lymphovascular invasion (LVSI) and IB1 cervical cancer were prospectively collected. All patients underwent cervical conization/s and laparoscopic nodal evaluation (pelvic lymphadenectomy/sentinel node mapping). Oncological and obstetrical outcomes were assessed.
RESULTS
Overall, 39 patients met inclusion criteria; 36 (92.3%) women were nulliparous. There were: 3 (7.7%) IA1-LVSI+; 11 (28.2%) IA2; and 25 (64.1%) IB1 cervical cancers, according to 2018 FIGO stage classification. Histological types were 22 (56.4%) squamous carcinoma and 17 (43.6%) adenocarcinoma. Pelvic lymphadenectomy was performed in 29 (74.4%) patients, while 10 (25.6%) patients had only sentinel node mapping. In 4 (10.3%) patients conservative treatment was discontinued due to nodal involvement and 2 (5.1%) patients requested definitive treatment (hysterectomy) after a negative lymph node evaluation. Among 33 (84.6%) patients who retained their childbearing potential, 17 (51.5%) had a second conization. 2 (6.1%) patients relapsed and underwent definitive treatment. After a median follow-up of 51 months (range 1-184) no deaths were reported. 22 (70.9%) patients attempted to conceive. There were 13 natural pregnancies among 12 (54.5%) women who got pregnant. Live birth rate was 76.9%: 9 (69.2%) term and 1 (7.7%) preterm (at 32 weeks) deliveries. 2 (15.4%) miscarriages (first and second trimester) and 1 (7.7%) termination of pregnancy for medical reasons were recorded.
CONCLUSION
Conization plus laparoscopic nodal evaluation may be a safe and feasible conservative option in the setting of fertility-sparing treatment for early-stage cervical cancer patients.
简介
评估保留生育潜能的早期宫颈癌患者行保守管理的肿瘤学和产科结局。
方法
前瞻性收集了因国际妇产科联合会（FIGO）分期为 IA1 伴淋巴血管侵犯（LVSI）和 IB1 宫颈癌行保留生育力治疗的年轻（<40 岁）女性的数据。所有患者均行宫颈锥切术和腹腔镜下淋巴结评估（盆腔淋巴结切除术/前哨淋巴结绘图）。评估肿瘤学和产科结局。
结果
总体而言，39 名患者符合纳入标准；36 名（92.3%）患者为未产妇。根据 2018 年 FIGO 分期分类，其中 3 例（7.7%）IA1-LVSI+；11 例（28.2%）IA2；25 例（64.1%）IB1 宫颈癌。组织学类型为 22 例（56.4%）鳞癌和 17 例（43.6%）腺癌。29 例（74.4%）患者行盆腔淋巴结切除术，10 例（25.6%）患者仅行前哨淋巴结绘图。由于淋巴结受累，4 例（10.3%）患者停止保守治疗，2 例（5.1%）患者在前哨淋巴结评估阴性后要求行根治性治疗（子宫切除术）。在保留生育能力的 33 名（84.6%）患者中，17 名（51.5%）行二次锥切术。2 例（6.1%）患者复发并接受根治性治疗。中位随访 51 个月（范围 1-184）后无死亡报告。22 例（70.9%）患者尝试妊娠。12 例（54.5%）妊娠患者中 13 例自然受孕。活产率为 76.9%：9 例（69.2%）足月产，1 例（7.7%）早产（32 周）。记录到 2 例（15.4%）自然流产（早、中期）和 1 例（7.7%）因医学原因终止妊娠。
结论
在早期宫颈癌的保留生育力治疗中，宫颈锥切术加腹腔镜下淋巴结评估可能是一种安全可行的保守选择。
Zotero 插件