Consultant Gynaecological Oncologist, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP, UK. Electronic address: Rachel.O'
Consultant Gynaecological Oncologist, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK.
Best Pract Res Clin Obstet Gynaecol. 2021 Sep;75:54-64. doi: 10.1016/j.bpobgyn.2021.05.002. Epub 2021 May 24.
There has been lively debate in recent years following the publication of various retrospective case series and small cohort studies that suggest certain women presenting with International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer (pre-2018 revised classification) may be treated by non-radical surgery, either simple hysterectomy or cone biopsy, where fertility preservation is required. A strictly defined histological criterion is necessary for selecting such cases, incorporating tumour dimensions including estimated tumour volume, lympho-vascular space invasion and pelvic lymph node status. Meta-analyses of these studies show that the oncological outcomes are comparable to the excellent results achieved by radical hysterectomy and radical trachelectomy. In addition, the fertility and pregnancy outcomes for cases treated by conisation are superior to cases managed by radical trachelectomy. Multi-centre, ethically approved, prospective studies are currently on-going, which will provide better quality evidence in an attempt to contribute to this debate, with the intention of improving outcomes, including quality of life, in women presenting with small-volume stage IB1 cervical cancer.
近年来，随着各种回顾性病例系列和小队列研究的发表，出现了激烈的争论，这些研究表明，对于某些国际妇产科联合会（FIGO）分期为 IB1 期的宫颈癌（2018 年前修订分类）患者，如果需要保留生育能力，可以采用非根治性手术，如单纯子宫切除术或锥形活检进行治疗。为了选择这些病例，需要有一个严格定义的组织学标准，包括肿瘤的尺寸，包括估计的肿瘤体积、淋巴管血管空间侵犯和盆腔淋巴结状态。对这些研究的荟萃分析表明，其肿瘤学结果与根治性子宫切除术和根治性宫颈切除术所取得的优异结果相当。此外，接受锥形切除术治疗的病例的生育和妊娠结局优于接受根治性宫颈切除术治疗的病例。目前正在进行多中心、符合伦理规范的前瞻性研究，这将提供更好质量的证据，试图为这一争论做出贡献，目的是改善包括小体积 IB1 期宫颈癌患者的生活质量在内的治疗结果。
