Northern Gynaecological Oncology Centre (NGOC), Queen Elizabeth Hospital, Gateshead, UK.
Northern Gynaecological Oncology Centre (NGOC), Queen Elizabeth Hospital, Gateshead, UK.
Gynecol Oncol. 2023 Sep;176:155-161. doi: 10.1016/j.ygyno.2023.07.018. Epub 2023 Aug 3.
Standard surgical treatment of FIGO stage 1B1 cervical cancer is open radical surgery. However, there is increasing evidence that for small tumours a more conservative approach can minimise fertility consequences without impacting on long term oncologic outcomes. The objective of our study is to present survival and obstetric outcomes following extended follow-up for patients who underwent conservative management of small-volume stage 1B1 disease.
All patients with FIGO stage 1B1 cancer and estimated tumour volume of <500 mm in a loop biopsy specimen treated in Northern Gynaecological Oncology Centre between December 2000 and December 2021, were included in the study. Clinico-pathological and demographic data were collated alongside detailed follow-up and obstetric outcomes in conjunction with primary care and death register.
117 patients underwent conservative surgery for small volume stage 1B1 disease. 58 (49.5%) underwent fertility sparing conservative management with LLETZ while 59 (50.5%) underwent simple hysterectomy. Overall, 95% (111/117) of the patients underwent bilateral pelvic lymphadenectomy and 1 positive node was identified. There was no death related to cervical cancer and 1 recurrence identified during a median follow up of 8.5 years (1-20). 17 pregnancies have been recorded in patients underwent LLETZ and 17 live babies were born. No second trimester miscarriages were noted and there was one preterm delivery (36 weeks).
Non-radical surgery with negative pelvic lymphadenectomy for smallvolume stage 1B1 cervical cancer ensures excellent survival without compromising obstetric outcomes. Should these results be verified by the ongoing prospective studies, radical surgery for these patients may be avoided.
FIGO 分期 1B1 期宫颈癌的标准手术治疗为开放性根治性手术。然而，越来越多的证据表明，对于小肿瘤，可以采用更为保守的方法，最大限度地减少对生育的影响，而不影响长期肿瘤学结局。本研究的目的是为在接受小体积 1B1 期疾病保守治疗的患者中进行长期随访后，报告其生存和产科结局。
纳入 2000 年 12 月至 2021 年 12 月期间在北妇科肿瘤中心接受治疗的FIGO 分期 1B1 期癌症且肿瘤体积估计<500mm 的患者，分析其临床病理和人口统计学数据，以及详细的随访和产科结局，同时结合初级保健和死亡登记。
117 例患者因小体积 1B1 期疾病行保守手术。58 例（49.5%）患者行保留生育力的 LLETZ 保守治疗，59 例（50.5%）行单纯子宫切除术。总体而言，95%（111/117）的患者行双侧盆腔淋巴结切除术，发现 1 例阳性淋巴结。无宫颈癌相关死亡，中位随访 8.5 年（1-20 年）期间发现 1 例复发。行 LLETZ 的患者中有 17 例妊娠，17 例活产。未发生中期流产，仅有 1 例早产（36 周）。
对于小体积 1B1 期宫颈癌行非根治性手术且行阴性盆腔淋巴结切除术可确保良好的生存，而不影响产科结局。如果这些结果能在正在进行的前瞻性研究中得到证实，那么这些患者可能无需行根治性手术。
