Conservative Therapy in Microinvasive Adenocarcinoma of the Uterine Cervix is Justified An Analysis of 59 Cases and a Review of the Literature
Conservative Therapy in Microinvasive Adenocarcinoma of the Uterine Cervix is Justified An Analysis of 59 Cases and a Review of the Literature
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DOI：
10.1097/igc.0b013e3182262059
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发表时间：
2011-12-01
影响因子：
4.8
通讯作者：
Helmerhorst, Theo J. M.
中科院分区：
文献类型：
--
作者：
Baalbergen, Astrid;Smedts, Frank;Helmerhorst, Theo J. M.
目的：本研究旨在评价IA1和IA2期子宫颈早期腺癌(AC)的治疗和随访，并广泛复习文献，以确定保守治疗是否合理。方法：检索荷兰鹿特丹地区1987年至2006年诊断的59例微侵袭性AC的记录。对临床和病理资料进行复习和分析。结果：在所有患者中，33例为IA1期，26例为IA2期。保守治疗42例(即锥切术或单纯子宫切除术)，根治性治疗17例(即根治性子宫切除/沙眼切除术加淋巴结清扫术)。1例(1.7%)IA1期腺癌(1级腺癌，深度1.4 mm，宽度3.8 mm，淋巴管间隙受累)行阴式子宫切除术后复发。平均随访79.9个月。从文献中综合IA1期和IA2期患者的资料，保守治疗后复发风险为1.5%，根治性治疗后复发风险为2.0%。结论：广泛的治疗，如广泛的子宫切除加盆腔淋巴结清扫或沙眼切除术，并不能预防复发。微侵袭性AC患者的治疗应与SCC患者相同。在IA1和IA2AC期，我们建议保守治疗(通过锥切术)。对于LVSI的病例，建议进行额外的淋巴清扫。对于IA2AC期伴LVSI的患者，应考虑行子宫切除术/根治性子宫切除术加淋巴结清扫术。
Objective: This study aimed to evaluate the treatment and follow-up in a large series of women with early cervical adenocarcinoma (AC), stages IA1 and IA2, and to perform an extensive review of the literature in an effort to ascertain whether conservative therapy is justified.Methods: Records of 59 cases of microinvasive AC diagnosed between 1987 and 2006 in the Rotterdam district, the Netherlands, were retrieved. Clinical and pathological data were reviewed and analyzed. A mesh review of all relevant literature concerning stage IA1 and IA2 was performed.Results: Of all patients, 33 had stage IA1 and 26 stage IA2 cervical AC. Also, 42 patients were treated conservatively (ie, conization or simple hysterectomy) and 17 patients were treated radically (ie, radical hysterectomy/trachelectomy with lymph node dissection). Recurrence occurred in 1 patient (1.7%) with stage IA1 disease (grade 1 adenocarcinoma, depth 1.4 mm, and width 3.8 mm, with lymph vascular space involvement [LVSI]) treated by vaginal hysterectomy. The mean follow-up was 79.9 months. From the literature, pooling all data from patients with stage IA1 and IA2 AC, the risk of recurrent disease was 1.5% after conservative therapy and 2.0% after radical therapy.Conclusions: Extensive treatment such as radical hysterectomy with pelvic lymph node dissection or trachelectomy does not prevent recurrent disease. Patients with microinvasive AC should be treated identically to patients with SCC. In stage IA1 and IA2 AC, we recommend conservative therapy (by conization). In cases with LVSI, an additional lymphadenectomy is advised. For patients with stage IA2 AC with LVSI, a trachelectomy/radical hysterectomy with lymph node dissection should be considered.