根治性子宫切除术治疗伴有盆腔淋巴结转移的ⅠB 期宫颈癌：比较完成手术与手术中止的效果。

Completed versus aborted radical hysterectomy for node-positive stage IB cervical cancer in the modern era of chemoradiation therapy.

机构信息

University of Alabama at Birmingham, Birmingham, AL, USA.

出版信息

Gynecol Oncol. 2012 Jul;126(1):69-72. doi: 10.1016/j.ygyno.2012.03.046. Epub 2012 Apr 5.

DOI:10.1016/j.ygyno.2012.03.046

PMID:22484400

Abstract

OBJECTIVE

Debate continues about optimal management of patients with node-positive stage I cervical cancer. Our objective was to determine if patient outcomes are affected by radical hysterectomy in the modern era of adjuvant chemoradiation.

METHODS

Cervical cancer patients diagnosed from 2000 to 2008 were identified. Demographics, therapy, clinicopathologic data, progression free survival (PFS), overall survival (OS), total radiation exposure, and grade 3-4 complications were analyzed by student t, Mann-Whitney, Fisher's exact, Kaplan-Meier, and log rank tests.

RESULTS

This single-institution review evaluated forty-one of 334 (13.4%) patients scheduled to undergo radical hysterectomy that had gross nodal disease diagnosed intraoperatively. 15 underwent aborted radical hysterectomy following lymphadenectomy; the remaining 26 underwent radical hysterectomy and lymphadenectomy. Eleven patients undergoing radical hysterectomy underwent whole pelvic radiation therapy (WPRT) while 8 (30.7%) patients underwent WPRT and postoperative vaginal brachytherapy (BT) for local treatment secondary to close margins. All patients undergoing aborted radical hysterectomy underwent WPRT and BT. With mean follow-up of 42.3 months, there were no significant differences in urinary, gastrointestinal, or hematologic complications between groups. When comparing those undergoing radical hysterectomy to aborted radical hysterectomy, there were no significant differences in local recurrence (11.5% vs 26.7%, p=0.39) or distant recurrence (19.2% vs. 33.3%, p=0.45), PFS (74.9 months vs 46.8 months, p=0.106), or OS (91.8 months vs 69.4 months, p=0.886).

CONCLUSIONS

Treatment of patients with early stage cervical cancer and nodal metastasis may be tailored intraoperatively. Completion of radical hysterectomy and lymphadenectomy decreases radiation exposure without apparently compromising safety or outcome in the era of adjuvant chemoradiation.

摘要

目的

关于淋巴结阳性Ⅰ期宫颈癌的最佳治疗方法仍存在争议。本研究旨在探讨在辅助放化疗的现代时代，根治性子宫切除术是否会影响患者的预后。

方法

回顾性分析 2000 年至 2008 年间诊断为宫颈癌的患者。分析患者的人口统计学、治疗方法、临床病理数据、无进展生存期（PFS）、总生存期（OS）、总辐射暴露量和 3-4 级并发症。采用学生 t 检验、Mann-Whitney 检验、Fisher 确切检验、Kaplan-Meier 法和对数秩检验进行数据分析。

结果

该单中心研究共纳入 334 例患者，其中 41 例（13.4%）患者计划行根治性子宫切除术，术中发现有淋巴结转移。15 例行淋巴结切除术的患者改行根治性子宫切除术+淋巴结切除术，其余 26 例行根治性子宫切除术+淋巴结切除术。11 例行根治性子宫切除术的患者行全盆腔放疗（WPRT），8 例（30.7%）患者因边缘接近而行 WPRT 联合阴道近距离放疗（BT）。所有行根治性子宫切除术+淋巴结切除术的患者均行 WPRT+BT。平均随访 42.3 个月，两组间在泌尿系统、胃肠道或血液学并发症方面无显著差异。比较根治性子宫切除术和根治性子宫切除术+淋巴结切除术两组，局部复发率（11.5% vs 26.7%，p=0.39）和远处复发率（19.2% vs 33.3%，p=0.45）、PFS（74.9 个月 vs 46.8 个月，p=0.106）和 OS（91.8 个月 vs 69.4 个月，p=0.886）均无显著差异。