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宫颈癌。

Cervical cancer.

机构信息

Department of Gynaecological Oncology, Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, Subiaco, Western Australia, WA, Australia; Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, WA, Australia.

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, TX, USA.

出版信息

Lancet. 2019 Jan 12;393(10167):169-182. doi: 10.1016/S0140-6736(18)32470-X.

Abstract

Each year, more than half a million women are diagnosed with cervical cancer and the disease results in over 300 000 deaths worldwide. High-risk subtypes of the human papilloma virus (HPV) are the cause of the disease in most cases. The disease is largely preventable. Approximately 90% of cervical cancers occur in low-income and middle-income countries that lack organised screening and HPV vaccination programmes. In high-income countries, cervical cancer incidence and mortality have more than halved over the past 30 years since the introduction of formal screening programmes. Treatment depends on disease extent at diagnosis and locally available resources, and might involve radical hysterectomy or chemoradiation, or a combination of both. Conservative, fertility-preserving surgical procedures have become standard of care for women with low-risk, early-stage disease. Advances in radiotherapy technology, such as intensity-modulated radiotherapy, have resulted in less treatment-related toxicity for women with locally-advanced disease. For women with metastatic or recurrent disease, the overall prognosis remains poor; nevertheless, the incorporation of the anti-VEGF agent bevacizumab has been able to extend overall survival beyond 12 months. Preliminary results of novel immunotherapeutic approaches, similarly to other solid tumours, have shown promising results so far.

摘要

每年有超过 50 万名女性被诊断出患有宫颈癌,该疾病导致全球超过 30 万人死亡。在大多数情况下,高危型人乳头瘤病毒(HPV)亚型是导致该疾病的原因。这种疾病在很大程度上是可以预防的。大约 90%的宫颈癌发生在缺乏有组织的筛查和 HPV 疫苗接种计划的低收入和中等收入国家。在高收入国家,自正式筛查计划推出以来,过去 30 年来,宫颈癌的发病率和死亡率已经减少了一半以上。治疗取决于诊断时疾病的程度和当地可用的资源,可能涉及根治性子宫切除术或放化疗,或两者的联合。对于低风险、早期疾病的女性,保留生育能力的保守手术已成为标准治疗方法。放射治疗技术的进步,如强度调制放射治疗,为局部晚期疾病的女性带来了较少的治疗相关毒性。对于转移性或复发性疾病的女性,总体预后仍然较差;尽管如此,抗血管内皮生长因子药物贝伐珠单抗的应用已能够将总生存期延长至 12 个月以上。新型免疫治疗方法的初步结果,与其他实体瘤类似,迄今为止显示出有希望的结果。

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