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Abstract：
BACKGROUND: Fertility-sparing surgery (FSS) is a viable option for young women with early-stage cervical cancer (ECC); however, certain risk factors may necessitate additional treatments and impact fertility. This review examines the prevalence of these risk factors and available treatment options.
METHODS: A systematic search was conducted of studies including patients with ECC (IA1 with LVSI, IA2, IB1 (FIGO 2009)) who underwent FSS.
RESULTS: Sixty-four articles, comprising a total of 4118 women planned for FSS, were included. High- or intermediate-risk histologic features were found in 638 (15.5%) women: 5.1% had positive lymph node(s), 4.1% had positive resection margins, 0.3% had parametrial involvement, 1.0% had unspecified high-risk features, and 5.1% had intermediate-risk histology (primarily based on the Sedlis criteria). Adjuvant treatment impaired fertility in all women with adjuvant hysterectomy and/or (chemo)radiation (58.7%). Adjuvant chemotherapy was given to 1351 (32.8%) patients, which may reduce fertility.
CONCLUSIONS: Fertility preservation could be achieved in most women; but high- or intermediate-risk factors necessitate more extensive surgery or radiotherapy leading to infertility. Adjuvant chemotherapy could be an alternative treatment option considering its effectiveness, safety and higher change in fertility preservation. The low incidence of parametrial involvement justifies waiving parametrectomy in tumors < 2 cm.
METHODS: A systematic search was conducted of studies including patients with ECC (IA1 with LVSI, IA2, IB1 (FIGO 2009)) who underwent FSS.
RESULTS: Sixty-four articles, comprising a total of 4118 women planned for FSS, were included. High- or intermediate-risk histologic features were found in 638 (15.5%) women: 5.1% had positive lymph node(s), 4.1% had positive resection margins, 0.3% had parametrial involvement, 1.0% had unspecified high-risk features, and 5.1% had intermediate-risk histology (primarily based on the Sedlis criteria). Adjuvant treatment impaired fertility in all women with adjuvant hysterectomy and/or (chemo)radiation (58.7%). Adjuvant chemotherapy was given to 1351 (32.8%) patients, which may reduce fertility.
CONCLUSIONS: Fertility preservation could be achieved in most women; but high- or intermediate-risk factors necessitate more extensive surgery or radiotherapy leading to infertility. Adjuvant chemotherapy could be an alternative treatment option considering its effectiveness, safety and higher change in fertility preservation. The low incidence of parametrial involvement justifies waiving parametrectomy in tumors < 2 cm.
摘要：
背景：保留生育力手术（FSS）对于患有早期宫颈癌（ECC）的年轻女性是可行的选择；然而，某些危险因素可能需要额外的治疗并影响生育能力.这篇综述研究了这些危险因素的患病率和可用的治疗方案。
方法：对包括ECC患者（IA1伴LVSI，接受FSS的IA2，IB1（FIGO2009）。
结果：64篇文章，由计划参加FSS的4118名妇女组成，包括在内。在638名（15.5%）女性中发现了高危或中危组织学特征：5.1%的患者淋巴结阳性，4.1%的切缘阳性，0.3%有宫旁受累，1.0%有未指定的高风险特征，5.1%的患者有中危组织学(主要基于Sedlis标准).辅助治疗损害了所有使用辅助子宫切除术和/或（化学）放疗的妇女的生育能力（58.7％）。1351例（32.8%）患者接受辅助化疗，这可能会降低生育率。
结论：在大多数女性中可以实现生育力保护；但是高危或中危因素需要更广泛的手术或放疗导致不孕。考虑到其有效性，辅助化疗可能是一种替代治疗选择，安全性和生育力保存的更高变化。宫旁受累的低发生率证明在<2cm的肿瘤中放弃宫旁切除术是合理的。
方法：对包括ECC患者（IA1伴LVSI，接受FSS的IA2，IB1（FIGO2009）。
结果：64篇文章，由计划参加FSS的4118名妇女组成，包括在内。在638名（15.5%）女性中发现了高危或中危组织学特征：5.1%的患者淋巴结阳性，4.1%的切缘阳性，0.3%有宫旁受累，1.0%有未指定的高风险特征，5.1%的患者有中危组织学(主要基于Sedlis标准).辅助治疗损害了所有使用辅助子宫切除术和/或（化学）放疗的妇女的生育能力（58.7％）。1351例（32.8%）患者接受辅助化疗，这可能会降低生育率。
结论：在大多数女性中可以实现生育力保护；但是高危或中危因素需要更广泛的手术或放疗导致不孕。考虑到其有效性，辅助化疗可能是一种替代治疗选择，安全性和生育力保存的更高变化。宫旁受累的低发生率证明在<2cm的肿瘤中放弃宫旁切除术是合理的。
