子宫颈癌:2025年最新进展

Cancer of the cervix uteri: 2025 update.

作者信息

Bhatla Neerja, Aoki Daisuke, Sharma Daya Nand, Sankaranarayanan Rengaswamy

机构信息

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Division of Preventive Medical Center, Akasaka Sanno Medical Center, Tokyo, Japan.

出版信息

Int J Gynaecol Obstet. 2025 Sep;171 Suppl 1:87-108. doi: 10.1002/ijgo.70277.

Abstract

Since the publication of the 2021 FIGO Cancer Report, there has been further progress in the global effort to attain the WHO goal of cervical cancer elimination using a three-pillar approach of vaccination, screening, and treatment. The HPV vaccination is now included in the national program of over 140 countries. Two-dose schedules are being implemented in 80 countries and one-dose schedules in 60 countries. Screening has seen major advances with the wider implementation of HPV testing, including the option of self-sampling, portable screening and treatment devices, and the incorporation of artificial intelligence. Diagnostic accuracy is being enhanced with immunohistochemistry and receptor assays. Surgical treatment of invasive cancer is being revolutionized with the possibility of conservative surgery in very early stages, minimizing complications and adverse effects and offering feasibility of fertility sparing. New data on minimally invasive surgery are redefining the role of laparoscopy and robotic surgery in early stages with small tumor size. Sentinel lymph node evaluation is an emerging alternative to complete lymphadenectomy. Immunotherapy has opened up new possibilities for the management of recurrent and metastatic disease. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality-of-life issues, with insights into the results from recent landmark trials.

摘要

自2021年《国际妇产科联盟(FIGO)癌症报告》发布以来,全球在采用疫苗接种、筛查和治疗这三大支柱方法实现世界卫生组织消除宫颈癌目标的努力中又取得了进一步进展。目前,人乳头瘤病毒(HPV)疫苗接种已纳入140多个国家的国家计划。80个国家正在实施两剂次接种计划,60个国家正在实施一剂次接种计划。随着HPV检测的更广泛应用,筛查取得了重大进展,包括自我采样、便携式筛查和治疗设备的选择,以及人工智能的纳入。免疫组织化学和受体检测正在提高诊断准确性。早期浸润性癌的手术治疗正在发生变革,极早期可行保守手术,最大限度地减少并发症和不良反应,并提供保留生育功能的可行性。关于微创手术的新数据正在重新定义腹腔镜手术和机器人手术在肿瘤体积小的早期阶段的作用。前哨淋巴结评估是全淋巴结清扫术的一种新兴替代方法。免疫疗法为复发性和转移性疾病的管理开辟了新的可能性。本章根据疾病分期讨论宫颈癌管理,包括对缓解和生活质量问题的关注,并深入了解近期具有里程碑意义的试验结果。

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