Adenocarcinoma in situ of the cervix:: A prospective study of conization as definitive treatment
Adenocarcinoma in situ of the cervix:: A prospective study of conization as definitive treatment
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DOI：
10.1006/gyno.2002.6758
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发表时间：
2002-09-01
影响因子：
4.7
通讯作者：
Nielsen, K
中科院分区：
文献类型：
--
作者：
Andersen, ES;Nielsen, K
Objective.本研究的目的是评价单纯联合激光锥切术作为原位腺癌（AIS）的确定性治疗的有效性和安全性，并评价保守预期策略的安全性，无论锥切缘状态如何。从1990年至2001年4月，连续60例经组织学证实的原位腺癌患者接受了联合激光锥切术治疗。在58例患者中，这被认为是最终治疗，患者平均随访49个月。平均年龄为34.9岁。锥切前评估显示AIS占76.7%。在58例病例中，锥切术被认为是最终治疗，其中15例涉及锥切边缘。27例患者（46.6%）随访超过60个月。共观察到4例复发（6.9%）。1例（6.7%）锥切术后4个月复发，3例（6.9%）未复发，其中2例锥切术后5年以上复发。随访期间未发现浸润性疾病。平均锥高为19 mm; 16.7%的锥活检超过25 mm。联合激光锥切术是AIS的有效治疗方法，并且在显著随访期后，无论锥切缘状态如何，基于细胞学的预期随访时间表均被证明是安全的。如果仅根据锥体边缘的状态进行进一步治疗，则存在过度治疗和患者不必要担忧的潜在风险。只有类似策略的前瞻性研究才能为AIS管理的有效建议提供足够的证据。(C)2002 Elsevier Science（美国）。
Objective. The aim of this study was to evaluate the efficacy and safety of combination laser conization alone as definitive treatment of adenocarcinoma in situ (AIS) and to evaluate the safety of a conservative expectant strategy irrespective of cone margin status.Methods. Sixty consecutive patients with histologically proven adenocarcinoma in situ were treated with combination laser conization from 1990 to April 2001. In 58 cases this was considered final therapy, and patients were followed for a mean period of 49 months.Results. The mean age was 34.9 years. Preconization evaluation demonstrated AIS in 76.7%. In 58 cases conization was considered final therapy, and in these cone margins were involved in 15 cases. Twenty-seven patients (46.6%) were followed for more than 60 months. Totally, 4 recurrences (6.9%) were observed. One recurrence was observed in patients with involved margins (6.7%) 4 months after conization, and 3 recurrences in patients with uninvolved margins (6.9%) were registered, in 2 cases more than 5 years after conization. No case of invasive disease was diagnosed during follow-up. The mean cone height was 19 mm; 16.7% of the cone biopsies were more than 25 mm.Conclusions. Combination laser conization was an effective treatment of AIS, and an expectant follow-up schedule based on cytology was demonstrated to be safe irrespective of cone margin status after a significant follow-up period. A potential risk of overtreatment and unnecessary worrying of the patients exists if further treatment is based solely on the status of the cone margins. Only prospective studies of similar strategies will give sufficient evidence for valid recommendations concerning the management of AIS. (C) 2002 Elsevier Science (USA).