Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP Centre, 20, rue Leblanc 75908 Paris Cedex 15, Paris, France.
Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP Centre, 20, rue Leblanc 75908 Paris Cedex 15, Paris, France; INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saint-Père, Paris, France.
J Gynecol Obstet Hum Reprod. 2024 Nov;53(9):102826. doi: 10.1016/j.jogoh.2024.102826. Epub 2024 Jul 27.
Adenocarcinoma in situ (AIS) of the cervix can progress to invasive adenocarcinoma. While hysterectomy is standard, conservative management may be considered for women desiring future pregnancies. This study aimed to determine the prevalence of residual disease in hysterectomy specimens following excisional therapy with clear margins for AIS.
A retrospective FRANCOGYN cohort study was conducted on patients who underwent a hysterectomy after conization with clear margins for AIS between 2008 and 2021. The primary goal was to assess the prevalence of residual disease in the hysterectomy specimens. Secondary objectives included identifying preoperative predictors of residual disease and comparing recurrence rates between patients with and without residual disease.
Of 53 hysterectomies performed after conization with negative margins for AIS, 20.8% (11/53) showed residual disease in the final histology. None of the patients had invasive cancer. In the residual disease group, 18% (2/11) had persistent CIN 3, and 82% (9/11) had persistent AIS. These patients tended to have higher BMI (27.5 kg/m² vs. 23.6 kg/m², p=0.04) and shorter endocervical margins (2mm vs. 5mm, p=0.01). No recurrences were observed during follow-up.
Despite clear margins on the initial conization for AIS, 20% of patients had residual disease in their hysterectomy samples, though no invasive cancer was found. A hysterectomy should be considered after completing childbearing, even if initial margins are clear.
宫颈原位腺癌（AIS）可进展为浸润性腺癌。子宫切除术是标准治疗方法，但对于希望未来生育的女性，也可考虑保守治疗。本研究旨在确定对于 AIS 患者行锥形切除术且切缘阴性后行子宫切除术时，子宫切除标本中是否存在残留疾病。
对 2008 年至 2021 年间行锥形切除术且切缘阴性的 AIS 患者进行了 FRANCOGYN 回顾性队列研究。主要目的是评估子宫切除标本中残留疾病的发生率。次要目标包括确定术前残留疾病的预测因素，并比较有残留疾病和无残留疾病患者的复发率。
在 53 例行锥形切除术且切缘阴性的子宫切除术中，有 20.8%（11/53）的患者在最终组织学检查中发现有残留疾病。所有患者均无浸润性癌。在残留疾病组中，18%（2/11）有持续的 CIN3，82%（9/11）有持续的 AIS。这些患者的 BMI 较高（27.5kg/m² 比 23.6kg/m²，p=0.04），且宫颈内口切缘较短（2mm 比 5mm，p=0.01）。在随访期间未观察到复发。
尽管 AIS 患者的初始锥形切除术切缘阴性，但仍有 20%的患者在子宫切除标本中存在残留疾病，尽管未发现浸润性癌。即使初始切缘阴性，在完成生育后也应考虑行子宫切除术。
