早期宫颈癌低危指标的探讨

Identification of Low-risk Indicators of Early Stage Cervical Cancer

目的探讨早期宫颈癌的低危指标。方法回顾性分析2000年3月至2011年4月在北京协和医院收治的行宫颈癌根治术治疗的临床分期为Ⅰa2期或Ⅰb1期(肿瘤直径≤2cm)的201例患者的手术病理资料,总结了术后肿瘤大小、宫旁浸润、子宫下段受累、阴道切缘阳性、淋巴结转移和淋巴血管间隙浸润(LVSI)等手术病理特点及患者预后情况。结果 201例患者中,宫旁浸润0例(0),子宫下段受累4例(1.99%),阴道切缘阳性14例(6.97%),淋巴结转移25例(12.44%),淋巴血管间隙浸润(LVSI)36例(17.41%)。术后大体病理未见明确肿物或肿瘤直径≤2 cm者147例(73.13%),肿瘤直径>2 cm者54例(26.87%);两组患者在肿瘤浸润≥1/2肌层(P=0.000)、LVSI阳性(P=0.019)、淋巴结转移(P=0.039)、子宫下段受累(P=0.008)、肿瘤中低分化(P=0.025)等方面差异有统计学意义。163例患者随诊3个月以上,有10例(6.13%)复发,其中7例(70%)2年内复发,平均复发时间为(26.4±7.31)个月(5～80个月);5例(50%)中心性复发,2例(20%)宫旁复发,3例(30%)远处转移;10例患者平均随诊(39.4±8.35)个月,尚无死亡病例。结论早期宫颈癌病理宫旁浸润发生率较低,肿瘤大小及肿瘤肌层浸润情况对低危患者的选择至关重要,可作为定义低危患者的指标。

Objective To explore the low-risk indicators of early cervical cancer.Methods The medical records of 201 patients undergoing radical surgery between March 2000 and April 2011 for staging Ia2,Ib1（tumor diameter≤2cm）cervix cancer were retrospectively reviewed,with particular focus on the pathological findings [parametrial involvement,positive margin,positive pelvic lymph node,and lymph vascular space invasion（LVSI）],treatment,and outcomes.Results The operation duration ranged 75-330min（mean：188.87min） and the intra-operative blood loss was approximately 100-2500 ml（mean：583.33 ml）.Pathology showed the rate of parametrial spread,positive margins,lymph node metastasis,LVSI was 0,6.97%,12.44%,and 17.41%.Based on the pathologic findings,the patients were classified as two groups：group A had 147 patients（73.13%） with no neoplasm or tumor diameter ≤2 cm,while group B had 54 patients（26.87%）with tumor diameter 2 cm.The incidence of ≥1/2 cervical stromal invasion,LVSI,positive lymph node,underlying section of uterus involvement,and low tumor differentiation in group A and B were 20.14% vs.85.19%（P=0.000）,13.61% vs.27.78%（P=0.019）,9.52% vs.20.37%（P=0.039）,4.82% vs.14.81%（P=0.008）,and 35.37% vs.44.44%（P=0.025）,respectively,with significant differences.Among the 163 patients who were followed up for more than 3 months,10（6.13%）developed recurrence whereas no patient died.Conclusions Pathologic parametrial involvement in clinical stage Ⅰa2 and Ⅰb1 cervical cancer is uncommon.Tumor size and cervical stromal invasion can be used to identify low-risk population that are worthy of consideration for studies of less radical surgery performed in conjunction with pelvic lymphadenectomy.