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Abstract：
Background: Recent publications underscore the need for updated recommendations addressing less radical surgery for <2 cm tumors, induction chemotherapy, or immunotherapy for locally advanced stages of cervical cancer, as well as for the systemic therapy for recurrent or metastatic cervical cancer. Aim: To summarize the current evidence for the diagnosis, treatment, and follow-up of cervical cancer and provide evidence-based clinical practice recommendations. Methods: Developed according to AGREE II standards, the guidelines classify scientific evidence based on the Agency for Health Technology Assessment and Tariff System criteria. Recommendations are graded by evidence strength and consensus level from the development group. Key Results: (1) Early-Stage Cancer: Stromal invasion and lymphovascular space involvement (LVSI) from pretreatment biopsy identify candidates for surgery, particularly for simple hysterectomy. (2) Surgical Approach: Minimally invasive surgery is not recommended, except for T1A, LVSI-negative tumors, due to a reduction in life expectancy. (3) Locally Advanced Cancer: concurrent chemoradiation (CCRT) followed by brachytherapy (BRT) is the cornerstone treatment. Low-risk patients (fewer than two metastatic nodes or FIGO IB2-II) may consider induction chemotherapy (ICT) followed by CCRT and BRT after 7 days. High-risk patients (two or more metastatic nodes or FIGO IIIA, IIIB, and IVA) benefit from pembrolizumab with CCRT and maintenance therapy. (4) Metastatic, Persistent, and Recurrent Cancer: A PD-L1 status from pretreatment biopsy identifies candidates for Pembrolizumab with available systemic treatment, while triplet therapy (Atezolizumab/Bevacizumab/chemotherapy) becomes a PD-L1-independent option. Conclusions: These evidence-based guidelines aim to improve clinical outcomes through precise treatment strategies based on individual risk factors, predictors, and disease stages.
摘要：
背景：最近的出版物强调需要更新的建议，以解决<2厘米肿瘤的根治性手术，诱导化疗,或局部晚期宫颈癌的免疫疗法，以及复发或转移性宫颈癌的全身治疗。目的:总结目前诊断的证据,治疗,和宫颈癌的随访并提供循证临床实践建议。方法：根据AGREEII标准开发，该指南根据卫生技术评估和关税系统标准对科学证据进行分类。建议根据发展小组的证据强度和共识水平进行分级。主要结果：（1）早期癌症：基质浸润和淋巴血管间隙受累（LVSI）从预处理活检确定候选手术，特别是简单的子宫切除术。（2）手术方式：不建议进行微创手术，除了T1A,LVSI阴性肿瘤，由于预期寿命的减少。（3）局部晚期癌症：同步放化疗（CCRT），然后进行近距离放射治疗（BRT）是基础治疗。低风险患者（少于两个转移淋巴结或FIGOIB2-II）可以在7天后考虑诱导化疗（ICT），然后进行CCRT和BRT。高风险患者（两个或更多转移性淋巴结或FIGOIIIA，IIIB,和IVA）受益于pembrolizumab与CCRT和维持治疗。（4）转移，持久性,和复发癌症：来自预处理活检的PD-L1状态可识别Pembrolizumab与可用的全身治疗的候选者，而三联疗法（阿替珠单抗/贝伐单抗/化疗）成为PD-L1非依赖性选择。结论：这些循证指南旨在通过基于个体风险因素的精确治疗策略来改善临床结果。预测因子,和疾病阶段。
