宫颈残端癌：213例病例回顾

Carcinoma of the cervical stump: a review of 213 cases.

作者信息

Barillot I, Horiot J C, Cuisenier J, Pigneux J, Schraub S, Rozan R, Pourquier H, Daly N, Vrousos C, Keiling R

机构信息

Radiotherapy Department, Centre Georges-François Leclerc, Dijon, France.

出版信息

Eur J Cancer. 1993;29A(9):1231-6. doi: 10.1016/0959-8049(93)90063-l.

DOI:10.1016/0959-8049(93)90063-l

PMID:8343259

Abstract

From 1970 to 1987, 213 cases of carcinoma of the cervical stump were accrued in a multi-institutional prospective cooperative study. This group accounted for 5.5% of cervical carcinoma diagnosed during the same period. 13 had in situ carcinoma and 200 had invasive carcinoma (96% squamous cell carcinoma, 4% adenocarcinoma). Radiotherapy alone (external and brachytherapy) was given to 77%, brachytherapy and surgery to 15% and surgery alone to 8%). FIGO stage distribution was: I (31%), IIa (15%), IIb (27%), IIIa (5%), IIIb (17%) and IV (5%). Five-year locoregional control per stage was 100% in Ia, 85% in Ib, 82% in IIa, 71% in IIb, 45% in IIIa, 54% in IIIb and 30% in IV. Corrected 5-year survival per stage was 82% in Ib, 78% in IIa, 73% in IIb, 69% in IIIa, 38% in IIIb and 0% in IV. The diameter of disease in stage II strongly influenced the 5-year locoregional control (81% for tumours of less than 3 cm vs. 68% for tumours more than 3 cm). Lymphangiogram was associated with a 44.5% 5-year locoregional control when positive vs. 74% when non-positive. Brachytherapy was advantageous in obtaining locoregional control in patients receiving external irradiation and brachytherapy: 81.5% vs. 38.5% in patients treated with external radiotherapy alone. Surgery was performed only for in situ carcinoma and for part of stages Ia, Ib and IIa. There is no significant difference in locoregional control at equal stage between radiotherapy alone and treatment schemes including surgery. However, lethal complications were observed in 6% of the patients of the surgical group as compared to 0.6% of the patients treated with radiotherapy alone. Radical radiotherapy seems to provide similar results of locoregional control and survival at equal stages in carcinoma of the cervical stump compared to carcinoma developed on an intact uterus. The rate of severe complications reported with the French-Italian glossary is 13% for G3 and 3% for G4, which is close to the observed rate during the same period in our series of radical radiotherapy to the intact uterus.

摘要

1970年至1987年期间，一项多机构前瞻性合作研究共收集了213例宫颈残端癌病例。该组病例占同期诊断出的宫颈癌病例的5.5%。其中13例为原位癌，200例为浸润癌（96%为鳞状细胞癌，4%为腺癌）。仅接受放疗（外照射和近距离放疗）的患者占77%，接受近距离放疗和手术的患者占15%，仅接受手术的患者占8%。国际妇产科联盟（FIGO）分期分布为：I期（31%）、IIa期（15%）、IIb期（27%）、IIIa期（5%）、IIIb期（17%）和IV期（5%）。各期的五年局部区域控制率分别为：Ia期100%、Ib期85%、IIa期82%、IIb期71%、IIIa期45%、IIIb期54%、IV期30%。各期校正后的五年生存率分别为：Ib期82%、IIa期78%、IIb期73%、IIIa期69%、IIIb期38%、IV期0%。II期疾病的直径对五年局部区域控制有很大影响（直径小于3 cm的肿瘤为81%，直径大于3 cm的肿瘤为68%）。淋巴管造影阳性时五年局部区域控制率为44.5%，阴性时为74%。在接受外照射和近距离放疗的患者中，近距离放疗在获得局部区域控制方面具有优势：单独接受外照射放疗的患者为38.5%，接受外照射和近距离放疗的患者为81.5%。手术仅用于原位癌以及部分Ia期、Ib期和IIa期患者。单纯放疗与包括手术的治疗方案在相同分期的局部区域控制方面无显著差异。然而，手术组有6%的患者出现致命并发症，而单纯接受放疗的患者这一比例为0.6%。与完整子宫发生的宫颈癌相比，根治性放疗在宫颈残端癌相同分期的局部区域控制和生存结果方面似乎相似。根据法意词汇表报告的严重并发症发生率，G3级为13%，G4级为3%，这与我们同期对完整子宫进行根治性放疗系列中的观察发生率相近。