Hellebrekers B. W. J., Zwinderman A. H., Kenter G. G., Peters A. A. W., Snijders-Keilholz A., Graziosi G. C. M., Fleuren G. J., Trimbos J. B.
Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands; Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
Int J Gynecol Cancer. 1999 May;9(3):212-219. doi: 10.1046/j.1525-1438.1999.99023.x.
The objectives of this study were to scrutinize surgical features and analyze local tumor parameters of early cervical cancer to identify patients at-risk for recurrent disease. Three hundred eight patients who underwent radical hysterectomy and pelvic lymphadenectomy between 1984 and 1997 were studied retrospectively. All radical hysterectomies were performed in a referral oncology center, and treatment policies and operating staff were the same during the study period. Operating time gradually decreased significantly during the study period from an average of 270 min to an average of 187 min (P < 0.0001), and blood loss during surgery also decreased continually from 1515 ml to 1071 ml (P < 0.0001). Postoperative radiation treatment was given to 119 patients (40%). The overall five-year survival rate was 83%, 91% for those with negative, and 53% for those with positive pelvic nodes. Univariate analysis showed that lymph node status, parametrial involvement, status of the surgical margins, capillary lymphatic space involvement, tumor size and depth of invasion were all significantly related to the occurrence of recurrent disease. Multivariate analysis revealed that lymph node involvement (hazard ratio 4.4), parametrial involvement, tumor size and depth of invasion were independent factors of prognostic significance for disease-free survival. It was concluded that the local control of cervical tumors infiltrating > 10 mm (hazard ratio 5.1) might be improved by adjuvant radiotherapy, even in the absence of lymph node metastasis, parametrial involvement or affected surgical margins.
本研究的目的是仔细检查早期宫颈癌的手术特征并分析局部肿瘤参数，以识别复发疾病的高危患者。对1984年至1997年间接受根治性子宫切除术和盆腔淋巴结清扫术的308例患者进行了回顾性研究。所有根治性子宫切除术均在一家转诊肿瘤中心进行，研究期间治疗政策和手术人员相同。在研究期间，手术时间从平均270分钟显著逐渐减少至平均187分钟（P < 0.0001），手术期间的失血量也从1515毫升持续减少至1071毫升（P < 0.0001）。119例患者（40%）接受了术后放射治疗。总体五年生存率为83%，盆腔淋巴结阴性者为91%，阳性者为53%。单因素分析显示，淋巴结状态、宫旁组织受累情况、手术切缘状态、毛细淋巴管间隙受累情况、肿瘤大小和浸润深度均与复发疾病的发生显著相关。多因素分析显示，淋巴结受累（风险比4.4）、宫旁组织受累、肿瘤大小和浸润深度是无病生存的独立预后因素。研究得出结论，即使在没有淋巴结转移、宫旁组织受累或手术切缘受影响的情况下，辅助放疗也可能改善浸润深度> 10毫米的宫颈肿瘤的局部控制（风险比5.1）。
