Individualizovaná chirurgická léčba cervikálních prekanceróz

English version

Authors: B. Sehnal ¹; D. Driák ¹; D. Cibula ²; M. Halaška ¹; P. Bolehovská ¹; J. Sláma ²
Authors‘ workplace: Onkogynekologické centrum, Gynekologicko-porodnická klinika 1. LF UK a Nemocnice Na Bulovce, Praha, přednosta prof. MUDr. M. Halaška, DrSc. ¹; Onkogynekologické centrum, Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc. ²
Published in: Ceska Gynekol 2014; 79(5): 372-377

Overview

Cíl studie:
Přehled nových znalostí, které by mohly pomoci v rozhodování o individualizované léčbě prekanceróz děložního hrdla.

Typ studie:
Souhrnný přehled.

Název a sídlo pracoviště:
Onkogynekologické centrum, Gynekologicko-porodnická klinika, Nemocnice Na Bulovce a 1. LF UK, Praha; Onkogynekologické centrum, Gynekologicko-porodnická klinika Všeobecné fakultní nemocnice a 1. LF UK, Praha.

Metodika a výsledky:
Prekancerózy děložního hrdla jsou zastoupeny dlaždicobuněčnými cervikálními intraepiteliálními neoplaziemi (CIN) a žlázovými adenocarcinomy in situ (AIS). Obvyklou léčbou prekanceróz děložního hrdla je konizace. Avšak některé komplikace, zvláště nežádoucí následky v pozdější graviditě, mohou doprovázet jakoukoliv chirurgickou léčbu děložního hrdla. U žen, které si přejí otěhotnět a mají CIN s nízkým rizikem transformace do invazivního karcinomu, může být terapie odložena. Výskyt blíže specifikujících faktorů by mohl pomoci rozčlenit CIN podle jejich maligního potenciálu. Význam by mohlo mít stanovení HPV genotypu, protože osud CIN 2/3 závisí na genotypu asociované HPV infekce. Cervikální léze spojené s HPV 16, 18 a 45 mají výrazně vyšší riziko progrese do invazivního karcinomu než léze asociované s jinými HR HPV genotypy. V individuálních případech by chirurgická léčba CIN 2/3 mohla být odložena u žen, které si přejí otěhotnět, pokud by léze nebyla asociována s HPV 16, 18 a 45. Použití biologických a molekulárních markerů, především p16INK4a, se pokouší upřesnit zhodnocení cervikálních lézí. Mladší věk, probíhající těhotenství, příznivý kolposkopický nález, negativní p16^INK4aa neoslabená imunita jsou nezávislé faktory podporující konzervativní management. Léčba adenocarcinomu in situ se podstatně liší od managementu CIN.

Závěr:
Je důležité správně zhodnotit všechny upřesňující okolnosti a minimalizovat nežádoucí účinky v důsledku zbytečné či nadbytečné chirurgické léčby prekanceróz děložního hrdla.

Klíčová slova:
cervikální intraepiteliální neoplazie, adenocarcinoma in situ, konizace, individualizovaná léčba, genotyp lidského papilomaviru, p16

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