Evaluation of adjuvant chemotherapy after abdominal trachelectomy for cervical cancer: a single-institution experience
Evaluation of adjuvant chemotherapy after abdominal trachelectomy for cervical cancer: a single-institution experience
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DOI：
10.1007/s10147-020-01778-8
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发表时间：
2020-09-03
影响因子：
3.3
通讯作者：
Kato, Kiyoko
中科院分区：
文献类型：
--
作者：
Okugawa, Kaoru;Yahata, Hideaki;Kato, Kiyoko
背景为避免生育能力丧失，宫颈切除术后应选择化疗作为辅助治疗。我们的研究评估了子宫颈癌经腹宫颈切除术后辅助化疗的有效性和安全性。方法本临床研究经机构审查委员会批准，并获得每位患者的知情同意书。2005年，我们开始在我们的机构进行腹部气管切开术。深基质浸润（超过2/3）伴淋巴血管间隙浸润、弥漫性宫颈浸润、阴道跳跃性病变、主韧带和阴道淋巴血管间隙浸润被定义为中危因素，宫旁浸润和盆腔淋巴结转移被定义为高危因素。有中、高危因素的患者行宫颈切除术后辅助治疗。回顾性审查了患者的病历和信息。结果截至2020年1月，我们进行了212例宫颈切除术。在纳入的患者中，分别有16例和7例中高危癌症患者在宫颈切除术后接受了辅助化疗（分别有2例和21例患者接受了腹部改良根治性宫颈切除术和根治性宫颈切除术）。在这些患者中，仅1例（4.3%）在中位术后随访80个月（范围12-146个月）后发生复发和随后死亡。5年生存率为95.5%。未观察到化疗相关的危及生命的急性不良事件。未发生持续性卵巢功能障碍和晚期不良事件。一名妇女怀孕三次，分娩了两名婴儿。结论腹腔镜下宫颈切除术后辅助化疗是一种有效、安全、保留生育能力的治疗方法。
Background To avoid the loss of fertility, chemotherapy should be chosen as an adjuvant treatment after trachelectomy. Our study evaluated the effectiveness and safety of adjuvant chemotherapy after abdominal trachelectomy for cervical cancer. Methods Our institutional review board approved this clinical study, and informed consent was obtained from each patient. We began performing abdominal trachelectomy at our institution in 2005. Deep stromal invasion (more than two-thirds) with lymphovascular space invasion, diffuse cervical invasion, skip lesions in the vagina, and lymphovascular space invasion in the cardinal ligament and vagina were defined as intermediate-risk factors, and parametrial invasion and pelvic lymph node metastasis were defined as high-risk factors. Patients who had intermediate- or high-risk factors received post-trachelectomy adjuvant treatment. The medical records and information of the patients were reviewed retrospectively. Results Through January 2020, we performed 212 trachelectomies. Among the included patients, 16 and 7 patients with intermediate- and high-risk cancer, respectively, received adjuvant chemotherapy after trachelectomy (2 and 21 patients underwent abdominal modified radical trachelectomy and radical trachelectomy, respectively). Among these patients, only one (4.3%) experienced relapse and subsequent death of the disease after a median postoperative follow-up of 80 months (range 12-146 months). The 5-year survival rate was 95.5%. Chemotherapy-related life-threatening acute adverse events were not observed. Persistent ovarian dysfunction and late adverse events did not occur. One woman achieved three pregnancies, and two infants were delivered. Conclusion Adjuvant chemotherapy after abdominal trachelectomy could be an alternative treatment option from the aspects of effectiveness, safety, and fertility preservation.