Early invasive adenocarcinoma of the uterine cervix: Criteria for nonradical surgical treatment
Early invasive adenocarcinoma of the uterine cervix: Criteria for nonradical surgical treatment
复制标题
DOI：
10.1006/gyno.2002.6624
复制
发表时间：
2002-05-01
影响因子：
4.7
通讯作者：
Ohmi, K
中科院分区：
文献类型：
--
作者：
Kasamatsu, T;Okada, S;Ohmi, K
客观的。这项回顾性研究的目的是确定早期宫颈浸润性腺癌非根治性手术的选择标准。方法。对 79 例经手术治疗的宫颈腺癌（浸润范围为 5 毫米或更小）的患者进行了临床病理学检查。根据FIGO（1995）分期系统进行间质侵犯的评估。结果。平均年龄为 46 岁（范围：29-73）岁，中位随访时间为 118（9-348）个月。最终治疗方式包括 71 例（89.9%）例行根治性子宫切除术，2 例（2.5%）例行改良根治性子宫切除术，6 例（7.6%）例行单纯筋膜外子宫切除术（不伴盆腔淋巴结切除）。术后辅助外部放射治疗 5 例（6.3%）例。组织学亚型为宫颈内膜型 37 例（46.8%）、子宫内膜样型32 例（40.5%）为腺鳞癌，10 例（12.7%）为腺鳞癌。41 例（51.9%）患者的病灶间质浸润长达 3 毫米；其中 24 例（58.5%）患者的病灶水平延伸长达 7 分钟（IA1 期）。38 例（48.1%）患者的病灶为间质浸润超过 3 分钟但不超过 3 分钟的不良病灶。 5 毫米；其中 4 例病灶水平延伸不超过 7 分钟（IA2 期），其中 1 例（1.4%）肿瘤（深度：5 毫米；宽度：15 毫米）存在宫旁转移（病灶深度：5 毫米；病灶宽度：16 毫米）。间质侵犯达 3 毫米的患者中有 88% 为高分化腺癌，而病灶侵犯超过 3 毫米的患者中有 53% 为高分化腺癌。在所有接受根治性子宫切除术的患者中，有 5 名（6.3%）复发并死亡，其中 1 名中央盆腔复发患者的病灶侵犯深度为 3 毫米，宽度为 7 毫米。结论：早期浸润性腺癌的间质浸润深度为 3 mm 或更少，包括符合FIGO IA1期标准的患者，可以接受简单的筋膜外子宫切除术，无需进行淋巴结切除术和卵巢切除术（C）2002 Elsevier Science（美国）。
Objective. This retrospective study was undertaken to identify selection criteria for nonradical surgery for early invasive adenocarcinoma of the uterine cervix.Methods. Seventy-nine patients with surgically treated cervical adenocarcinomas (with invasion to 5 mm or less) were examined clinicopathologically. The evaluation of stromal invasion was conducted according to the FIGO (1995) staging system.Results. The mean age was 46 (range: 29-73) years, and the median follow-up was 118 (9-348) months. Definitive treatment modalities included radical hysterectomy in 71 (89.9%) cases, modified radical hysterectomy in 2 (2.5% and simple extrafascial hysterectomy without pelvic lymphadenectomy in 6 (7.6%). Postoperative adjuvant external radiation therapy was given to 5 (6.3%) patients. The histological subtypes were endocervical in 37 (46.8%) cases, endometrioid in 32 (40.5% and adenosquamous in 10 (12.7%). Forty-one (51.9%) patients had lesions with up to 3 mm of stromal invasion; of these, 24 (58.5%) had lesions with up to 7 min of horizontal extension (stage IA1). Thirty-eight (48.1%) patients bad lesions with stromal invasion greater than 3 min and no greater than 5 mm; of these, 4 had lesions with no wider than 7 min of horizontal extension (stage IA2). Of 73 patients with pelvic lymphadenectomy, one (1.4%) tumor (depth: 5 mm; width: 15 mm) had node metastases. Parametrial involvement was present in one (1.4%) patient (lesion depth: 5 mm; lesion width: 16 mm). None had adnexal metastasis. Eighty-eight percent of the patients with stromal invasion up to 3 mm had well-differentiated adenocarcinoma, compared to 53% of the patients with lesions invading more than 3 mm. Of all of the patients, 5 (6.3%) patients who received curative radical hysterectomies had recurrences and died. Among 5 patients, one patient with central pelvic recurrence had a lesion invading to a depth of 3 mm and width of 7 mm, and the others had lesions with more than 3 mm of invasion and 15 to 36 mm of width.Conclusions. Patients with early invasive adenocarcinoma to a depth of 3 mm or less stromal invasion, including those who meet the criteria for FIGO stage IA1, may be treated with simple extrafasicial hysterectomy without lymphadenectomy and oophorectomy. (C) 2002 Elsevier Science (USA).