Ng Zheng Yuan, Manchanda Ranjit, Lopez Aldo, Obermair Andreas, Dostalek Lukas, Pareja Rene, van Lonkhuijzen Luc R C W, Falconer Henrik, Ortiz David Isla, Fagotti Anna, Ramirez Pedro T, Landoni Fabio, Weinberger Vit, Laky Rene, Kim Sarah H, Klat Jaroslav, Kocian Roman, Pari Darwin, Borcinova Martina, Nemejcova Kristyna, Cibula David
Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic; Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore.
Wolfson Institute of Preventive Medicine, Barts Cancer Centre, Queen Mary University of London, & Barts Health NHS Trust, London, UK.
Gynecol Oncol. 2024 Dec;191:95-99. doi: 10.1016/j.ygyno.2024.09.022. Epub 2024 Oct 8.
Patients with TNM T1a cervical cancer have excellent prognosis; however, the risk for recurrence remains an issue of concern and management guidelines are based on limited data. Here we performed subgroup analysis of the Surveillance in Cervical Cancer (SCCAN) consortium with the objective of defining the prognosis of T1a cervical cancer patients.
SCCAN was an international, multicentric, retrospective cohort study of patients with cervical cancer undergoing surgical treatment in tertiary centers. Inclusion criteria included: histologically confirmed cervical cancer treated between 2007 and 2016; TNM T1a; primary surgical management; and at least 1-year of follow-up data availability. Exclusion criteria included treatment with primary chemo-radiation, and missing treatment-related or clinical data.
Out of 975 patients included, 554 (57 %) were T1a1 and 421 (43 %) T1a2. The majority had squamous-cell carcinoma (78 %). 79 patients (8.1 %) had lymphovascular space invasion (LVSI). 455 patients (47 %) underwent radical hysterectomy/ parametrectomy. Laparoscopic and open surgery was performed in 401 (41 %) and in 361 (37 %) patients, respectively. Adjuvant treatment was administered to 56 patients (5.7 %). Assessment of lymph nodes (LN) was performed in 524 patients (54 %), with LN involvement found in 15 (2.9 %). There were 40 (4.1 %) recurrences, occurring at a median of 26 months (4-106), out of which 33 (82.5 %) occurred in pelvis. Among T1a1 cases, there were 10 recurrences (2.0 %) if LVSI was negative, and 3 recurrences (6.7 %) if LVSI was positive. Among T1a2 cases, there were 23 recurrences (6.7 %) if LVSI was negative, and 4 recurrences (5.1 %) if LVSI was positive. There were 3 recurrences in the LN+ group (recurrence rate 20 %).
The risk of recurrence in T1a cervical cancer was 4.1 % corresponding to the rates seen in patients with FIGO 1B cancer in recently published prospective trials. LN involvement represents a risk factor for disease recurrence. Our results indicate that stage T1a cervical cancer, apart from T1a1 LVSI negative disease, should follow the same principles in the management as that of FIGO stage 1B cancer.
TNM T1a期宫颈癌患者预后良好；然而，复发风险仍是一个值得关注的问题，且管理指南所依据的数据有限。在此，我们对宫颈癌监测（SCCAN）联盟进行了亚组分析，目的是明确T1a期宫颈癌患者的预后情况。
SCCAN是一项针对在三级中心接受手术治疗的宫颈癌患者的国际多中心回顾性队列研究。纳入标准包括：2007年至2016年间接受组织学确诊的宫颈癌治疗；TNM T1a期；主要采用手术治疗；以及至少有1年的随访数据。排除标准包括接受原发性放化疗，以及缺少治疗相关或临床数据。
在纳入的975例患者中，554例（57%）为T1a1期，421例（43%）为T1a2期。大多数患者为鳞状细胞癌（78%）。79例患者（8.1%）有脉管间隙浸润（LVSI）。455例患者（47%）接受了根治性子宫切除术/盆腔脏器切除术。分别有401例（41%）和361例（37%）患者接受了腹腔镜手术和开放手术。56例患者（5.7%）接受了辅助治疗。524例患者（54%）进行了淋巴结（LN）评估，其中15例（2.9%）发现有LN转移。共有40例（4.1%）复发，中位复发时间为26个月（4 - 106个月），其中33例（82.5%）发生在盆腔。在T1a1病例中，LVSI阴性时复发10例（2.0%），LVSI阳性时复发3例（6.7%）。在T1a2病例中，LVSI阴性时复发23例（6.7%），LVSI阳性时复发4例（5.1%）。LN阳性组有3例复发（复发率20%）。
T1a期宫颈癌的复发风险为4.1%，与近期发表的前瞻性试验中FIGO 1B期癌症患者的复发率相当。LN转移是疾病复发的一个危险因素。我们的结果表明，除了T1a1期LVSI阴性疾病外，T1a期宫颈癌的管理应遵循与FIGO 1B期癌症相同的原则。
