早期子宫颈癌患者术后盆腔淋巴囊肿的发生情况及原因分析

目的：探究早期子宫颈癌患者接受手术治疗后盆腔淋巴囊肿的发生及其与临床病理因素的相关性。方法：回顾性分析2013年1月至2015年12月,以及2019年1月至2019年12月于云南省肿瘤医院妇科接受初始根治性手术的663例早期子宫颈癌患者的临床资料,并根据术后是否发生盆腔淋巴囊肿分为淋巴囊肿组和无淋巴囊肿组。采用单因素和多因素Logistic回归分析术后盆腔淋巴囊肿形成的危险因素。结果：663例接受手术治疗的早期子宫颈癌患者术后盆腔淋巴囊肿的发生率为62.59%(415/663)。单因素分析显示盆腔淋巴囊肿的发生与使用的引流管类型和术后是否接受辅助化疗有关（P <0.05）。多因素分析结果显示使用负压引流管是术后盆腔淋巴囊肿发生的保护因素（P <0.05）。单因素分析显示盆腔淋巴囊肿的发生时间与FIGO分期、肿瘤分化程度、子宫颈肌壁浸润深度、切除淋巴结总数、切除髂总淋巴结总数、是否存在淋巴结转移、使用引流管类型和术后是否接受放化疗有关（P <0.05）。多因素分析显示使用负压引流管、术后未接受辅助放化疗是淋巴囊肿早期形成的保护因素（P <0.05）。结论：相较传统T型引流管,使用负压引流管可能可以降低早期子宫颈癌患者术后盆腔淋巴囊肿的发生率;术后接受辅助放化疗的患者发生盆腔淋巴囊肿的时间可能更早。     

早期低危子宫颈癌诊疗进展

由于宫颈细胞学及人乳头瘤病毒(HPV)联合筛查技术应用,增加了早期宫颈癌的检出率,早期低危子宫颈癌手术治疗效果满意,低危标准包括:宫颈肿瘤最大径线≤2 cm;浸润间质深度≤10 mm;无淋巴脉管间隙浸润。低危子宫颈癌伴有宫旁受累、淋巴结转移及切缘阳性的几率低,总体预后较好。因此认为对低危子宫颈癌患者可以实施保守的手术方法:保留神经的子宫颈癌根治术不影响患者排便、排尿功能,提高了患者术后的生活质量;术前磁共振成像预测术后宫旁受累的敏感度较高,子宫切除术后意外发现的早期低危子宫颈癌患者残留疾病的发生率和辅助治疗的几率非常低,可避免根治性宫旁切除;保留生育功能的手术包括单纯宫颈切除、宫颈锥切术以及根治性宫颈切除术,复发率与根治性子宫切除相当,且妊娠结局良好。对于宫颈微小浸润腺癌,其手术治疗程序应该与鳞癌相同。     

子宫颈癌术后规范化治疗对肿瘤学预后影响研究

目的 探讨国际妇产科联盟(FIGO)2018分期ⅠA～ⅡA期子宫颈癌患者术后辅助治疗的规范性对肿瘤学结局的影响.方法 在中国子宫颈癌临床诊疗项目大数据库中筛选FIG02018Ⅰ A～ⅡA期接受规范手术治疗的子宫颈癌患者,比较术后治疗规范与术后治疗不规范患者的5年总体生存率(OS)和无瘤生存率(DFS).结果 (1)纳入...     

子宫颈癌手术治疗质量控制需要注意的几个问题北大核心CSCD

开腹广泛性子宫切除术+盆腔淋巴结切除术±腹主动脉旁淋巴结切除术是早期子宫颈癌手术的标准术式。子宫颈癌手术需重视手术途径、子宫颈周围切除范围、并发症控制、辅助治疗规范化、标本观察和解剖以及围手术期快速康复。     

早期宫颈癌保留生育功能手术5例临床分析

目的:为保留早期宫颈癌患者的生育功能,实施广泛宫颈切除及盆腔淋巴结清扫术。方法:对2003年4月至2004年4月收治的要求保留子宫的5例早期宫颈癌患者采用经腹腔镜辅助的广泛宫颈切除及盆腔淋巴结清扫术。结果:5例患者在术中及术后均无并发症发生,术后1个月恢复正常月经,随访未发现复发癌。结论:早期子宫颈癌实施腹腔镜辅助的广泛宫颈切除及盆腔淋巴结清扫术可以保留患者的生育功能。     

早期子宫颈癌行机器人手术系统免举宫器联合经阴道封闭肿瘤广泛性子宫切除术20例分析

目的探讨机器人手术系统在早期子宫颈癌免举宫器联合经阴道封闭肿瘤广泛性子宫切除术中临床应用效果。方法对2019年1—9月南昌大学第一附属医院收治的20例早期子宫颈癌患者,应用机器人手术系统完成免举宫器联合经阴道封闭肿瘤广泛性子宫切除术,观察治疗效果。结果 20例患者均完成机器人手术,无中转开腹及输血,平均手术时间(210.6±20.7)min,平均术中出血量(100.7±30.5)mL,左侧宫旁组织宽度(2.4±0.7)cm,右侧宫旁组织宽度(2.5±0.8)cm,阴道壁组织切除长度(3.1±0.9)cm,清扫淋巴结数目(21.0±6.5)枚。1例髂外血管点状撕裂在腹腔镜下行缝合术止血。术中无输尿管及肠管损伤。术后根据病理结果给予放化疗等辅助治疗,术后随访4～40周患者无死亡及复发。结论早期子宫颈癌行机器人手术系统免举宫器联合经阴道封闭肿瘤广泛性子宫切除术是安全可行的。     

妇科恶性肿瘤盆腔淋巴结切除术后淋巴囊肿诊治专家共识（2020年版）

子宫颈癌、子宫内膜癌和卵巢癌是女性生殖系统最常见的三大恶性肿瘤,总体治疗原则是以手术治疗为主,术后依据指征给予相应的辅助治疗。盆腔淋巴结切除术作为妇科恶性肿瘤手术治疗的重要组成部分,在肿瘤的治疗、精准分期、术后辅助治疗指导、预后结局判断等方面具有不可或缺的价值。 浏览更多请关注本刊微信公众号     

子宫颈癌手术治疗及放化疗新观点

子宫颈癌的病因已经明晰,然而治疗方法并未发生重大变革,早期患者采取手术治疗,中晚期患者采取放化疗,依然是目前主要的治疗方法。手术治疗微创化是临床医学发展的必然趋势,腹腔镜手术治疗子宫颈癌已经显现出巨大的优势,但是由于初期实践者缺乏微创无瘤防御的理念和严格的规范操作,造成术后患者复发率增高。故亟待总结经验,持续改进完善。手术切除范围更加强调精准化和个体化,趋向于避免盲目广泛切除正常组织,有助于降低手术难度和并发症,尤其注重于保护生育功能和免疫功能。新辅助化疗虽然作为权宜之计,但是越发彰显重要作用。术后是否选择放疗至关重要,放疗指征更加精细化和标准化。     

子宫颈癌术前辅助治疗的规范化

新辅助化疗（neoadjuvant  chemotherapy, NACT）是子宫颈癌术前或放疗前辅助治疗的主要方式,原则上适用于局部晚期（ⅠB3 ～ⅣA期）和部分特殊类型的子宫颈癌患者。顺铂为首选药物,推荐化疗2～3个疗程。肿瘤直径大于4 cm的ⅠB3～ⅡA2期的子宫颈鳞癌和腺癌的部分患者可以采用新辅助化疗+根治性手术+盆腔淋巴结切除术的治疗模式。子宫颈小细胞神经内分泌肿瘤采用新辅助化疗后行全子宫切除术,术后辅助性放疗或同期放化疗,后续再联合其他全身治疗。规范应用NACT术前辅助治疗子宫颈癌,严格把握适应证,充分发挥其疗效优势至关重要。     

子宫颈癌的治疗动向

近年来 ,为了提高子宫颈癌患者的生存率及生存质量 ,广大妇科肿瘤临床工作者在子宫颈癌的治疗方面进行了许多有益探索 ,并取得了可喜的进展。一、子宫颈癌治疗模式的变化上个世纪 80年代前 ,子宫颈癌治疗是以放射治疗 (放疗 )为主。根据国际年报 19期统计 ,子宫颈癌患者接受单纯放疗者占 6 5 1% ,其次是单纯手术及术后放疗[1] 。而 1993～ 1995年间 ,单纯放疗仅为4 4 8% ,单纯手术及术后放疗比例并未提高。引人注意的是 ,术前化学药物治疗 (化疗 )、放疗前化疗(统称为新辅助化疗 ,neoadjuvantchemotherapy)、术前放疗及放、化疗同时进行的…     

Advances in the management of cervical cancer

In the last decade a number of advances have occurred in the treatment of cervical cancer. These advances have resulted in a variety of benefits, including improved survival, improved quality of life and preservation of fertility in selected patients with early-stage disease. Because cervical cancer affects women earlier than does any other adult cancer, appropriate physician decisions can significantly affect longevity. This article reviews recent advances in the management of cervical cancer, including conservative surgery for microinvasive tumors, radical trachelectomy, adjuvant therapy for high-risk early-stage disease, use of chemotherapy as part of multimodality primary treatment and improvements in the management of recurrent disease. Recognition of these advances is important for the practicing obstetrician/gynecologist.     

Adjuvant treatment in cervical,vaginal and vulvar cancer

Primary surgical management is successful as the sole therapeutic modality in the majority of women with early-stage cervical, vaginal and vulvar cancer, but the presence of certain risk factors in the surgico-pathological specimen indicates a poorer prognosis. Adjuvant treatment can improve overall survival in such cases. Important risk factors in cervical cancer include intermediate-risk factors (large tumor size, deep cervical stromal invasion, lymph-vascular space invasion) and high-risk factors (positive or close margins, lymph nodes, or parametrial involvement). In vulvar cancer, positive margins and lymph nodes are the two most important factors for adjuvant therapy. Radiation therapy has been the mainstay of adjuvant therapy in these cancers, supplemented by chemotherapy. Recent advances have witnessed the inclusion of newer therapeutic modalities such as immunotherapy. This review addresses the current status of various adjuvant therapeutic modalities for these gynecological cancers.     

Operative management of cervical cancer

Radical abdominal hysterectomy with pelvic lymph node dissection remains the treatment of choice for most patients with early-stage cervical cancer. The radicality and extent of lymph node dissection and parametrial resection should be tailored to tumour- and patient-related risk factors. Adjuvant therapy after radical surgery improves local control in high-risk patients and some intermediate-risk patients. The absolute indications for adjuvant therapy include multiple or macroscopically involved nodes, parametrial invasion and positive surgical margins. Adjuvant therapy may be given as chemoradiation or as radiotherapy alone, depending on risk assessment and expected morbidity. Primary chemoradiation is an equally effective alternative, but adjuvant surgery or finishing hysterectomy after pelvic radiation is not beneficial. Promising new developments include neo-adjuvant chemotherapy followed by surgery for bulky early-stage disease, tailoring radicality to reduce therapeutic morbidity and integrating minimal access surgical techniques into current treatment protocols.     

Adjuvant therapy for early-stage endometrial cancer: a review

Most patients with endometrial cancer (EMC) present their symptoms early in their course, leading to an overall favorable outcome. However, some patients who are in early-stage diseases may carry some risk features that would hamper their prognoses. For these early-stage diseases with high risk of recurrences, radiation therapy certainly plays a major role as an adjuvant treatment. Despite an excellent local diseases control by radiation, systemic failures are still encountered. To improve the prognoses, other types of adjuvant therapy have been attempted. In this review, various options of adjuvant treatment for this early-stage EMC including radiation therapy, chemotherapy, and hormonal therapy are discussed.     

Early-stage squamous cell and adenocarcinoma of the cervix.

Articles on early-stage squamous cell and adenocarcinoma of the cervix published between August 1990 and July 1991 are reviewed. A new monoclonal antibody used to distinguish endocervical from endometrial differentiation is described, as well as a histochemical means of distinguishing in situ from invasive adenocarcinoma. In vitro and in vivo studies of cell lines immortalized with human papillomavirus DNA are described with a discussion of the mechanism of the development of malignancy. An animal model to test and develop an anti-human papillomavirus vaccine is presented. The epidemiology of adenocarcinoma is also reviewed, and the development of invasive carcinoma after conservative therapy or conization for dysplasia is discussed. Computed tomography scanning has been found to be no more accurate than examination for staging of early cervical cancer. Several studies in the review period have evaluated risk factors for recurrent disease in patients treated for early-stage cervical cancer, including a prospective surgical pathologic study by the Gynecologic Oncology Group. The optimal treatment of early stage I adenocarcinoma of the cervix is discussed, comparing the efficacy of primary surgical therapy with the efficacy of radiation therapy. The risk of ovarian metastases in patients with early-stage cervical cancer is very low for both squamous cell and adenocarcinoma. The surgical technique and efficacy of laparoscopic pelvic lymphadenectomy for patients with early-stage cervical cancer are discussed. Lateral transposition of the ovaries at the time of radical hysterectomy for cervical cancer has significant potential benefits but also risks. Finally, surveillance methods that detect recurrent cervical cancer after treatment for early-stage disease are discussed.     

Adjuvant treatment for early-stage endometrial cancer

A subgroup of endometrial cancer patients with early-stage disease will progress or eventually present with recurrent disease. Multiple risk stratification strategies have been attempted to direct adjuvant therapeutic interventions. Radiation has been the most common form of adjuvant therapy offered to these patients. Unfortunately, its use has not translated into survival improvements. There is growing evidence supporting the use of adjuvant chemotherapy and multimodal interventions for patients with endometrial cancer. This review focuses on the role of adjuvant therapies for patients with early-stage disease with emphasis on future directions for risk stratification and personalized treatment.     

Endometrial cancer: molecular and therapeutic aspects

Endometrial cancer (EC) is the most commonly diagnosed gynecologic malignancy. Although early-stage EC is effectively treated surgically, commonly without adjuvant therapy, the treatment of high-risk and advanced disease is more complex. Chemotherapy has evolved into an important modality in high-risk early-stage and advanced-stage disease, and in recurrent EC. Multi-institutional trials are in progress to better define optimal adjuvant treatment for subsets of patients, as well as the role of surgical staging in reducing both overuse and underuse of radiation therapy.     

Clinical significance of serum human papillomavirus DNA in cervical carcinoma

OBJECTIVE: To study the association between serum human papillomavirus (HPV) deoxyribonucleic acid (DNA) and clinicopathologic prognostic factors and the clinical usefulness of serum HPV DNA in early-stage cervical cancer. METHODS: Deoxyribonucleic acids extracted from cervical tissues and sera of patients with stage IB or IIA cervical cancer and 40 controls including patients with cervical carcinoma in situ or benign disease were examined for HPV DNA with L1 consensus and types 16- and 18-specific E7 primers. Multivariable logistic regression was used to determine significant correlates of positive serum HPV DNA, and the receiver operating characteristic curve was applied in risk-factor assessment. RESULTS: Human papillomavirus DNA was not detected in sera from patients with carcinoma in situ or benign disease. Among the 112 patients with cervical cancer, we detected 27 positive samples (24.1%) in serum. Positive HPV DNA in serum was significantly associated with lymphovascular invasion and deep stromal invasion with or without parametrial extension (P <.001 for both conditions), pelvic lymph nodal metastasis (P =.001), large tumor size, and elevated levels of serum squamous cell carcinoma antigen (P <.001 for both conditions). When serum HPV DNA was used to predict high-risk patients who require adjuvant therapy, a sensitivity of 45.2%, a specificity of 88.6%, a positive predictive value of 70.4%, and a negative predictive value of 72.9% were obtained. CONCLUSION: The presence of serum HPV DNA in patients with early-stage cervical cancer was correlated with poor prognosis factors that warrant adjuvant therapy.     

Fertility-sparing Surgery for Patients with Cervical,Endometrial, and Ovarian Cancers

ObjectiveNearly 10% of the 1.3 million women living with a gynecologic cancer are aged <50 years. For these women, although their cancer treatment can be lifesaving, it's also life-altering because traditional surgical procedures can cause infertility and, in many cases, induce surgical menopause. For appropriately selected patients, fertility-sparing options can reduce the reproductive impact of lifesaving cancer treatments. This review will highlight existing recommendations as well as innovative research for fertility-sparing treatment in the 3 major gynecologic cancers.Tabulation, Integration, and ResultsFor early-stage cervical cancers, fertility-sparing surgeries include cold knife conization, simple hysterectomy with ovarian preservation, or radical trachelectomy with placement of a permanent cerclage. In locally advanced cervical cancer, ovarian transposition before radiation therapy can help preserve ovarian function. For endometrial cancers, fertility-sparing treatment includes progestin therapy with endometrial sampling every 3 to 6 months. After cancer regression, progestin therapy can be halted to allow attempts to conceive. Hysterectomy with ovarian preservation can also be considered, allowing for fertility using assisted reproductive technology and a gestational carrier. For ovarian cancers, fertility-sparing surgery includes unilateral salpingo-oophorectomy or bilateral salpingo-oophorectomy (with lymphadenectomy and staging depending on tumor histology). With higher-risk histology or higher early-stage disease, adjuvant chemotherapy is recommended—however, this carries a 3% to 10% risk of ovarian failure. Use of oocyte or embryo cryopreservation in patients with early-stage ovarian malignancy remains an area of ongoing research.ConclusionOverall, fertility-sparing management of gynecologic cancers is associated with acceptable rates of progression-free survival and overall survival and is less life-altering than more radical surgical approaches.     

Chemotherapy for high-risk early-stage endometrial cancer

PURPOSE OF REVIEW: To discuss the usefulness of chemotherapy in high-risk early-stage endometrial cancer and the best chemotherapy regimen. RECENT FINDINGS: External radiation therapy has been successfully used to prevent local recurrence; however, it does not improve the overall survival and it increases the incidence of late toxicity. A recent randomized study revealed that adjuvant platinum-based combination chemotherapy might be a suitable alternative to radiotherapy for high-risk early-stage endometrial cancer. The optimal regimen is still in question because combinations of doxorubicin-cisplatin and paclitaxel-doxorubicin-cisplatin cause significant toxicity. The combination of paclitaxel-carboplatin may be better than doxorubicin-cisplatin with regard to toxicities. SUMMARY: Radiation treatment following surgery has been the standard adjuvant therapy for endometrial cancer for a long time. Radiotherapy decreases the local recurrence rates; however, a significant impact on the overall survival has not been demonstrated. The usefulness of adjuvant chemotherapy has been demonstrated by only a little evidence. Nonetheless, we are encouraged by a recent randomized study. In light of the excellent outcomes associated with early-stage endometrial cancer, it is important to conduct another large randomized trial based on standardization of high-risk criteria to evaluate the efficacy of adjuvant chemotherapy.