Cervical cancer is a major health issue worldwide, with approximately 660,000 new cases a year, particularly in women of reproductive age (47.4 ± 12.8 years at diagnosis). Current advances in screening and immunization have shifted cervical cancer diagnoses to earlier stages; as a result, fertility preservation is an essential component of building a treatment plan.Objectives:This systematic review aims to synthesize the existing techniques for fertility preservation with a focus on early-stage cervical cancer (cancer stage IA1-IB1). We will describe the different surgical and medical approaches for the treatment of cervical cancer, followed by an analysis of their oncologic safety and the associated reproductive risks and outcomes.Methods:A descriptive synthesis of the strategies for surgical management, including conization, radical trachelectomy, neoadjuvant chemotherapy (NACT), and radiotherapy, was completed. Fertility and successful pregnancy rely on patient selection, prognostic variables, and obstetric outcomes. The use of transposition of the ovaries and cryopreservation in the context of gonadotoxic treatment plans also requires investigation.Results:For patients meeting conservative eligibility criteria, conservative surgery for tumors up to 2 cm has been considered a safe oncological management strategy, although evidence remains limited. Pregnancy rate after conization ranged from 36 to 55% and 10 to 38% after radical trachelectomy. Ovarian function can be successfully preserved in >60% of laparoscopic transposition cases but resulted in a less than 15% chance of natural conception; the need for assistive reproductive techniques was often required.Conclusions:Fertility-preserving management of cervical cancer is safe and feasible in carefully selected patients, with oncologic outcomes comparable to more radical management. Continued innovation and randomized control trials in treatment paths and oncologic and fertility outcomes will benefit the field.
宫颈癌是全球范围内的重大健康问题，每年新增病例约66万例，尤其好发于育龄期女性（确诊年龄47.4±12.8岁）。当前筛查与免疫接种技术的进步使宫颈癌诊断趋于早期化，因此生育力保存成为制定治疗方案的重要组成部分。 研究目的： 本系统综述旨在整合现有生育力保存技术，重点关注早期宫颈癌（IA1-IB1期）。我们将阐述宫颈癌治疗的不同手术与医学方法，并分析其肿瘤安全性、相关生殖风险及预后结局。 研究方法： 通过描述性综合分析法，系统梳理宫颈锥切术、根治性宫颈切除术、新辅助化疗及放射治疗等手术管理策略。生育力与成功妊娠取决于患者选择、预后变量及产科结局。针对性腺毒性治疗方案中的卵巢移位术与冷冻保存技术亦需深入探讨。 研究结果： 对于符合保守治疗标准的患者，肿瘤直径≤2cm的保守手术被认为是安全的肿瘤管理策略，但相关证据仍有限。宫颈锥切术后妊娠率为36%-55%，根治性宫颈切除术后为10%-38%。腹腔镜卵巢移位术可成功保留超过60%患者的卵巢功能，但自然受孕概率低于15%，通常需要辅助生殖技术介入。 研究结论： 对经严格筛选的宫颈癌患者实施生育力保存治疗安全可行，其肿瘤学结局与根治性治疗相当。在治疗路径、肿瘤学及生育结局方面持续开展创新研究与随机对照试验，将推动该领域进一步发展。
Cervical Cancer Treatment and Fertility: What We Know and What We Do
肿瘤(癌症)患者之家