Choi D H, Huh S J, Nam K H
Department of Radiation Oncology, Soonchunhyang University Hospital, Yongsan-gu, Seoul, South Korea.
Gynecol Oncol. 1997 Jun;65(3):506-11. doi: 10.1006/gyno.1997.4711.
Total vaginal or abdominal hysterectomy was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was inadvertently performed on patients who were thought preoperatively to have benign or premalignant conditions. Between 1985 and 1993, 64 patients undergoing hysterectomy in the presence of invasive cervical cancer were treated with external radiation therapy and/or intracavitary radiotherapy. Preoperative diagnoses were carcinoma in situ (36), severe dysplasia (2), and early invasive cancer (14), and others were benign disease. Overall 5-year survival and relapse-free survival rates were 75.8 and 77.5%, respectively. For patients in retrospective stage IA, IB, and IIB (gross residual after surgery), overall 5-year survival rates were 90.9, 88.8, and 27.9%, respectively. Thirteen patients developed treatment failure; most of them (10/13) were patients with gross residual disease. Patients with early invasive cervical cancer (stage IA) had no treatment-related failure. Prognostic factors affecting survival by univariate analysis were retrospective stage (P = 0.0000) and preoperative diagnosis (P = 0.0021). Tumor histology was marginally significant factor (P = 0.0938). By multivariate analysis, only retrospective stage was significant prognostic factor (P = 0.0001). Adjuvant radiotherapy appears to be an effective treatment method for patients with presumed stage IA and IB after inadvertent hysterectomy. Survival for patients with gross disease remaining after inappropriate hysterectomy is poor. So, early cancer detection and proper management with precise pretreatment staging is necessary to avoid inadherent hysterectomy, especially in cases of gross residual disease.
全阴道或腹式子宫切除术被认为是浸润性宫颈癌的一种不充分的治疗方法。通常，该手术是在术前被认为患有良性或癌前病变的患者身上无意中进行的。1985年至1993年间，64例在存在浸润性宫颈癌的情况下接受子宫切除术的患者接受了外照射放疗和/或腔内放疗。术前诊断为原位癌（36例）、重度发育异常（2例）和早期浸润癌（14例），其他为良性疾病。总体5年生存率和无复发生存率分别为75.8%和77.5%。对于回顾性分期为IA期、IB期和IIB期（手术后有大体残留）的患者，总体5年生存率分别为90.9%、88.8%和27.9%。13例患者出现治疗失败；其中大多数（10/13）是有大体残留疾病的患者。早期浸润性宫颈癌（IA期）患者没有与治疗相关的失败情况。单因素分析中影响生存的预后因素是回顾性分期（P = 0.0000）和术前诊断（P = 0.0021）。肿瘤组织学是边缘性显著因素（P = 0.0938）。多因素分析显示，只有回顾性分期是显著的预后因素（P = 0.0001）。辅助放疗似乎是无意中进行子宫切除术后假定为IA期和IB期患者的一种有效治疗方法。不适当子宫切除术后仍有大体疾病残留的患者生存率较差。因此，早期癌症检测以及精确的术前分期进行适当管理对于避免不适当的子宫切除术是必要的，尤其是在有大体残留疾病的情况下。
