全球子宫颈癌前病变及宫颈癌治疗指南制订现状的系统综述  

Global guidelines for cervical cancer and precancerous lesions treatment:a systematic review

作　　者：赵爽 陈号 赵方辉 Zhao Shuang;Chen Hao;Zhao Fanghui(Department of Epidemiology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;School of Public Health,Xiamen University,Xiamen 361102,China)

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院,流行病学研究室,北京100021 [2]厦门大学公共卫生学院,厦门361102

出　　处：《中华医学杂志》2022年第22期1666-1676,共11页National Medical Journal of China

基　　金：国家重点研发计划(2018YFC1315504);美国中华医学基金会卫生政策与体系科学公开竞标项目(16-255)。

摘　　要：目的系统梳理与总结全球子宫颈癌前病变及宫颈癌治疗指南的制订现状和推荐意见。方法以"uterine cervical neoplasms""cervix cancer""cervical neoplasm""cervical precancerous lesions""treat*""guideline*""practice guideline*""consensus""recommendation*""guidebook*""子宫颈癌前病变""宫颈癌""治疗""指南""规范""共识"为关键词,检索PubMed、Embase、中国生物医学文献服务系统、中国知网和万方数据库截至2021年7月8日收录的文章,辅以检索世界各国的卫生网站最新的与子宫颈癌前病变和宫颈癌治疗相关的指南,语种限定为中文和英文。共纳入文献38篇,对指南的基本信息、针对不同人群的推荐意见等进行摘录和整理分析。结果共纳入国内外24部子宫颈癌前病变治疗指南和14部宫颈癌治疗指南,覆盖亚洲、欧洲、北美洲、南美洲和大洋洲。大多数指南对宫颈上皮内瘤变1级(CIN1)人群推荐随访观察;针对宫颈上皮内瘤变2/3级(CIN2/CIN3)人群,视患者具体情况推荐消融治疗或切除治疗,其中发达国家指南优先推荐采用切除治疗。在中低资源国家,鉴于医疗资源的可及性,推荐在阴道镜检查满意时消融治疗可作为切除治疗的替代疗法;针对原位腺癌(AIS)人群,视患者有无生育需求推荐宫颈锥切术或全子宫切除术;针对宫颈癌患者,大多数指南推荐采用手术治疗早期疾病和较小病变,同步放化疗通常是中晚期宫颈癌的主要治疗方法。在治疗后的人群管理方面,所有指南均推荐治疗后应进行长期随访监测疾病复发情况,随访方法包括人乳头瘤病毒(HPV)检测和(或)细胞学检查或阴道镜检查。针对子宫颈癌前病变,大多数指南推荐治疗后的6或12个月进行随访,针对宫颈癌推荐治疗后的3~4个月进行随访。结论全球不同国家和地区发布的子宫颈癌前病变及宫颈癌的治疗推荐具有一定差异。需在充分借鉴全球治疗指南的基础上,考虑不Objective To systematically summarize current status and recommendations of the global cervical cancer and precancerous lesions treatment guidelines.Methods The retrieval for all the Chinese and English literature published before July 8,2021 was conducted in PubMed,Embase,SinoMed Database,CNKI and Wanfang Database,supplemented by a search of health websites of countries worldwide,with"uterine cervical neoplasms""cervix cancer""cervical neoplasm""cervical precancerous lesions""treat*""guideline*""practice guideline*""consensus""recommendation*""guidebook*"in English as well as"cervical precancerous lesions""cervical neoplasm""treatment""guideline*""consensus"in Chinese as search keywords.A total of 38 guidelines were included for data extraction and analysis.Results Guidelines covered Asia,Europe,North America,South America and Oceania.Conservative observation was recommended for the CIN1 population.For the women with CIN2/CIN3,ablation or excision was recommended according to the specific situation and guidelines of developed countries give priority to the latter.In low and middle resource countries,given the availability of medical resources,ablative treatment was recommended as an alternative to excisional treatment if the women were eligible.For women with adenocarcinoma in situ(AIS),cervical conization or total hysterectomy was recommended depending on the patient′s desire of fertility.For patients with cervical cancer,most guidelines recommended surgery for early disease and smaller lesions,otherwise concurrent chemoradiotherapy was usually the main treatment modality for advanced cancers.All guidelines recommended long-term follow-up to monitor disease recurrence after treatment.Follow-up methods included human papillomavirus(HPV)testing and/or cytology or colposcopy.Most guidelines recommended follow-up at 6 or 12 months after treatment for cervical precancerous lesions,and 3~4 months for cervical cancer.Conclusions There are some differences in the treatment and management recommendations for cervical

关 键 词：宫颈肿瘤 子宫颈癌前病变 治疗 指南 

分 类 号：R737.33[医药卫生—肿瘤]