Hoorshad Niloufar, Zamani Narges, Sheikh Hasani Shahrzad, Poopak Amirhossein, Sharifi Amirsina
Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran.
Department of Gynecology Oncology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Ann Med Surg (Lond). 2022 Jun 20;79:104020. doi: 10.1016/j.amsu.2022.104020. eCollection 2022 Jul.
There was an increase in number of patients presented with early-stage cervical cancer (CC). Tumors with favorable pathological features might be candidates for less radical surgery.
We retrospectively reviewed 700 patients with histologically confirmed CC between January 2011 and March 2020. Chi-square, Fisher's exact tests and multivariate logistic regression analysis were used to assess relations between parametrial involvement (PI) and clinic-pathological variables.
Total number of 132 patients with stage IA to IIA were eligible to participate. Squamous cell carcinoma was reported in 100 (75.8%) patients, adenocarcinoma and other tumor pathologies were found in 24(18.2%) and 8(6.1%), respectively. Considering the 2018 FIGO stage, 11 (8.4%) patients had IA, 111 (83%%) IB and 10 (7.6%) IIA. Nine patients (6.8%) had PI on permanent pathologic report. Univariate analysis demonstrated that following variables were statistically different between patients with and without PI: age ≥50, tumor size ≥ 3 cm, lower segment involvement, poorly differentiated pathology, deep stromal invasion, pelvic lymph node, lympho-vascular involvement and positive surgical margin (all p values < 0.05). Among these variables only tumor size ≥3 cm (OR: 2.1, 95% CI: 1.11-4.16, p value: 0.02), deep stromal invasion (OR: 2.2, 95% CI: 1.9-7.43, p value: 0.02) and positive surgical margin (OR: 5.1, 95% CI: 3.97-11.15, p value: 0.008) were independent risk factor of PI in multivariate analysis.
Early stage CC might be surgically approached in a more conservative manner if patients have tumor size <3 cm and do not have deep stromal invasion in conization.
早期宫颈癌（CC）患者数量有所增加。具有良好病理特征的肿瘤可能适合进行不太激进的手术。
我们回顾性分析了2011年1月至2020年3月期间700例经组织学确诊为CC的患者。采用卡方检验、Fisher精确检验和多因素逻辑回归分析来评估宫旁组织受累（PI）与临床病理变量之间的关系。
共有132例IA期至IIA期患者符合参与条件。其中100例（75.8%）为鳞状细胞癌，24例（18.2%）为腺癌，8例（6.1%）为其他肿瘤病理类型。根据2018年国际妇产科联盟（FIGO）分期，11例（8.4%）为IA期，111例（83%）为IB期，10例（7.6%）为IIA期。9例（6.8%）患者的永久病理报告显示存在PI。单因素分析表明，有PI和无PI的患者在以下变量上存在统计学差异：年龄≥50岁、肿瘤大小≥3 cm、宫颈下段受累、病理分化差、深层间质浸润、盆腔淋巴结转移、淋巴血管浸润和手术切缘阳性（所有p值<0.05）。在多因素分析中，这些变量中只有肿瘤大小≥3 cm（比值比：2.1，95%置信区间：1.11 - 4.16，p值：0.02）、深层间质浸润（比值比：2.2，95%置信区间：1.9 - 7.43，p值：0.02）和手术切缘阳性（比值比：5.1，95%置信区间：3.97 - 11.15，p值：0.008）是PI的独立危险因素。
如果患者肿瘤大小<3 cm且锥切术中无深层间质浸润，早期CC可能可以采用更保守的手术方式。
