Yoneoka Yutaka, Kato Mayumi Kobayashi, Tanase Yasuhito, Uno Masaya, Ishikawa Mitsuya, Murakami Takashi, Kato Tomoyasu
Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan.
Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan.
Obstet Gynecol Sci. 2021 Mar;64(2):226-233. doi: 10.5468/ogs.20243. Epub 2021 Jan 8.
This study aimed to investigate the prognosis of patients with intermediate-risk cervical cancer and to evaluate the necessity of adjuvant therapy.
We conducted a retrospective chart review of patients with stage IB-II cervical cancer who underwent type III radical hysterectomy with pelvic lymphadenectomy between 2008 and 2017. In our institution, radical hysterectomy is performed as an open surgery and not as a minimally invasive surgery, and adjuvant therapy is not administered to patients with intermediate-risk cervical cancer. The intermediate-risk group included patients with 2 or more of the following factors: tumor size >4 cm, stromal invasion >1/2, and lymphovascular stromal invasion. Intermediaterisk patients with squamous cell carcinoma were included in the I-SCC group, whereas those with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma were included in the I-Adeno group.
There were 34 and 18 patients in the I-SCC and I-Adeno groups, respectively. The 5-year recurrence-free survival (RFS) and overall survival rates in the I-SCC group were 90.5% (95% confidence interval [CI], 85.3-95.7%) and 100% (95% CI, 100%), respectively, whereas those in the I-Adeno group were 54.9% (95% CI, 42.0-67.9%) and 76.1% (95% CI, 63.7-88.4%), respectively. Multivariate analysis revealed that endocervical adenocarcinoma, usual type, or adenosquamous carcinoma, and tumor size >4 cm had worse RFS.
The I-SCC group had good prognosis without adjuvant therapy; therefore, adjuvant therapy may be omitted in these patients. In contrast, the I-Adeno group had poor prognosis without adjuvant therapy; therefore, adjuvant therapy should be considered in their treatment.
本研究旨在调查中危型宫颈癌患者的预后情况，并评估辅助治疗的必要性。
我们对2008年至2017年间接受III型根治性子宫切除术及盆腔淋巴结清扫术的IB-II期宫颈癌患者进行了回顾性病历审查。在我们机构，根治性子宫切除术采用开放手术而非微创手术，中危型宫颈癌患者不接受辅助治疗。中危组包括具有以下2项或更多因素的患者：肿瘤大小>4 cm、间质浸润>1/2以及淋巴管间质浸润。鳞状细胞癌的中危患者纳入I-SCC组，而宫颈内膜腺癌（普通型）或腺鳞癌患者纳入I-Adeno组。
I-SCC组和I-Adeno组分别有34例和18例患者。I-SCC组的5年无复发生存率（RFS）和总生存率分别为90.5%（95%置信区间[CI]，85.3 - 95.7%）和100%（95% CI，100%），而I-Adeno组分别为54.9%（95% CI，42.0 - 67.9%）和76.1%（95% CI，63.7 - 88.4%）。多因素分析显示，宫颈内膜腺癌（普通型）或腺鳞癌以及肿瘤大小>4 cm的患者RFS较差。
I-SCC组在不进行辅助治疗的情况下预后良好；因此，这些患者可省略辅助治疗。相比之下，I-Adeno组在不进行辅助治疗的情况下预后较差；因此，在其治疗中应考虑辅助治疗。
