Management of invasive carcinoma of the uterine cervix associated with pregnancy: Outcome of intentional delay in treatment
Management of invasive carcinoma of the uterine cervix associated with pregnancy: Outcome of intentional delay in treatment
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DOI：
10.1006/gyno.2002.6813
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发表时间：
2002-11-01
影响因子：
4.7
通讯作者：
Kanazawa, K
中科院分区：
文献类型：
--
作者：
Takushi, M;Moromizato, H;Kanazawa, K
目标。目的：探讨浸润性宫颈癌合并妊娠患者，特别关注经计划延迟治疗以提高胎儿成熟度后的母婴结局。回顾性分析了28例妊娠期及妊娠后1个月内诊断为浸润性宫颈癌的病例。22名患者（79%）为I期疾病，6名患者（21%）为II期或III期疾病。肿瘤组织学表现为鳞状细胞癌27例，腺癌1例。22周前诊断20例，22 ~ 36周诊断4例，36周后诊断1例，产后诊断3例。立即治疗组（16例）3例为IA期，7例为IB期，6例为II期或III期。11例患者在治疗性流产或胎儿原位流产后行子宫切除术。2例患者行剖宫产手术后行子宫切除术或放疗。3例产后确诊患者均行子宫切除术或放疗。15例患者在27 ~ 114个月的随访中无疾病。延迟治疗组（n = 12） IA1期8例，IA2期1例，1B1期2例，1B2期1例。在8例IA1期肿瘤患者中，治疗延迟至足月，延迟6至25周，并在分娩后进行子宫切除术或治疗性切除。在4例IA2、1B1或1B2期肿瘤患者中，治疗延迟至妊娠30周后，延迟6至15周。无疾病进展记录。在这些患者中，剖宫产后进行子宫切除术。在70 ~ 156个月的随访中，所有患者均无疾病，婴儿健康，无后遗症。对于伴有妊娠的早期I期宫颈癌患者，延迟治疗以使胎儿成熟是安全的。(C) 2002 Elsevier Science （USA）。
Objective. To investigate patients with invasive cervical carcinoma associated with pregnancy, with special reference to the maternal and neonatal outcomes after planned treatment delay to improve fetal maturity.Methods. The medical records of 28 patients with invasive cervical carcinoma diagnosed during pregnancy or within 1 month after pregnancy were retrospectively reviewed.Results. Twenty-two patients (79%) had Stage I disease and 6 (21%) had Stage II or III disease. Tumor histology revealed squamous cell carcinoma in 27 cases and adenocarcinoma in 1. Twenty cases were diagnosed before 22 weeks gestation, 4 between 22 and 36 weeks, I after 36 weeks gestation, and 3 were diagnosed postpartum. In the immediate treatment group (n = 16), the diseases were Stage IA in 3 cases, IB in 7, and II or III in 6. In 11 patients, hysterectomy was performed after therapeutic abortion or with fetus in situ. In 2 patients, cesarean section was followed by hysterectomy or radiotherapy. Three patients diagnosed postpartum were treated with either hysterectomy or radiotherapy. Fifteen patients were free of disease during the follow-up of 27 to 114 months. In the delayed treatment group (n = 12), the diseases were Stage IA1 in 8 cases, IA2 in 1, 1B1 in 2, and 1B2 in 1 case. In 8 patients with Stage IA1 tumor, the treatment was deferred until term with a delay of 6 to 25 weeks, and hysterectomy or therapeutic conization was performed after delivery. In 4 patients with Stage IA2, 1B1 or 1B2 tumor, the treatment was postponed until after 30 weeks gestation with a delay of 6 to 15 weeks. No disease progression was documented. Cesarean delivery was followed by hysterectomy in these patients. All patients were free from disease during the follow-up of 70 to 156 months and their babies were well with no sequelae.Conclusion. Delay in treatment to allow for fetal maturity is safe in patients with early Stage I cervical carcinoma associated with pregnancy. (C) 2002 Elsevier Science (USA).