宫颈癌：法国宫颈癌指南小组制定的国家临床实践指南。
完整摘要 · 中文译文
过去十年间，宫颈癌的管理发生了重大变化，手术方式、手术根治程度、淋巴结分期、影像学、放疗技术、近距离放疗及全身治疗均有显著进展。为统一临床实践并将新证据整合为可适用的临床建议，法国宫颈癌指南工作组制定了宫颈癌患者管理的国家临床实践指南。该指南制定过程在法国国家妇产科医师学会的支持下开展，并由代表参与宫颈癌诊疗的法国各科学学会的多学科专家小组参与实施。临床问题采用PICO框架制定，涵盖诊疗全程，包括初次评估、影像学、诊断性锥切、手术淋巴结分期、治疗、生育力保留、疗效评估、随访、复发及特殊临床情况。证据依据GRADE方法进行审查和严格评价，所有建议均基于2018年FIGO分期系统。外部验证通过两轮德尔菲法完成，共87位独立评审专家参与。总体而言，130个PICO问题生成了158条建议，其中35条为强推荐，52条为弱推荐，另有71个问题未能形成推荐意见。改变临床实践的关键建议包括诊断性锥切在早期病变评估中的作用，以及自IB1期起避免采用微创子宫切除术。 疾病、风险适应的手术根治性、前哨淋巴结活检联合超分期检查、放化疗后图像引导的近距离放疗，以及在选定的局部晚期或转移性情况下整合帕博利珠单抗（PEMBROLIZUMAB）治疗。
完整摘要 · 英文原文
Over the past decade, cervical cancer management has evolved substantially, with major changes in surgical approach, surgical radicality, nodal staging, imaging, radiotherapy techniques, brachytherapy and systemic treatments. To harmonize practice and integrate new evidence into clinically applicable recommendations, the French Cervical Cancer Guidelines Group developed national clinical practice guidelines for the management of patients with cervical cancer. The guideline process was conducted under the auspices of the French National College of Obstetricians and Gynecologists and involved a multidisciplinary expert panel representing the French scientific societies involved in cervical cancer care. Clinical questions were formulated using the PICO framework and addressed the full continuum of care, including initial assessment, imaging, diagnostic conization, surgical nodal staging, treatment, fertility preservation, response assessment, follow-up, recurrence and specific clinical situations. Evidence was reviewed and critically appraised according to the GRADE methodology, and all recommendations were based on the 2018 FIGO staging system. External validation was performed through a two-round Delphi process involving 87 independent reviewers. Overall, 130 PICO questions generated 158 recommendations, including 35 strong and 52 weak recommendations, while no recommendation could be issued for 71 questions. Key practice-changing recommendations include the role of diagnostic conization in early-stage assessment, avoidance of minimally invasive hysterectomy from stage IB1 disease, risk-adapted surgical radicality, sentinel lymph node biopsy with ultrastaging, image-guided brachytherapy after chemoradiotherapy, and integration of PEMBROLIZUMAB in selected locally advanced or metastatic settings.