Lacorre A, Merlot B, Garabedian C, Narducci F, Chereau E, Resbeut M, Minsat M, Leblanc E, Houvenaeghel G, Lambaudie E
Department of Gynecology and Obstetrics, Hospital of Limoges, France, 8 Avenue Dominique Larrey, 87042 Limoges Cedex, France; Department of Surgery, Institut Paoli Calmettes Cancer Center, 232, Boulevard Sainte-Marguerite, 13273 Marseille, France.
Department of Surgery, Oscar Lambret Center, 3 rue Frédérique Combemale, 59020 Lille, France.
Eur J Surg Oncol. 2016 Mar;42(3):376-82. doi: 10.1016/j.ejso.2015.12.003. Epub 2015 Dec 17.
Two options are possible for the management of early stage cervical cancer, without lymph node involvement: radical surgery or brachytherapy followed by surgery. The aim of this study was to compare overall survival (OS) and disease-free survival (DFS) of early stage cervical cancers managed by uterovaginale brachytherapy followed by extrafasciale hysterectomy (group 1) or by radical hysterectomy alone (group 2). The secondary objectives were to compare the morbidity of these two different approaches and to evaluate the parametrial involvement rate in patients managed by radical hysterectomy.
It is a retrospective and collaborative study between the Paoli Calmettes Institute (Marseille) and the Oscar Lambret Center (Lille) from 2001 to 2013, in patients with tumors FIGO stages IA1, IA2, IB1 and IIA less than 2 cm of diameter, without pelvic lymph node involvement.
One hundred and fifty-one patients were included (74 in group 1 and 77 in group 2). The demographic characteristics of the two groups were comparable. OS and DFS were respectively 92.3% versus 100% (p = 0.046) and 92.3% and 98.7% (p = 0.18). Complication rates were 12.2% and 44.2%, respectively (p < 0.0001). In group 2, the parametrial invasion rate in this study was 1.30%.
In our study, the two strategies are comparable in terms of DFS. Complications seem more frequent in the group 2, but more severe in the group 1. Finally, the low rate of parametrial invasion in group 2 confirms the interest of a less radical surgical treatment in these stages with good prognosis.
对于无淋巴结转移的早期宫颈癌，有两种治疗方案可供选择：根治性手术或近距离放疗后手术。本研究的目的是比较接受子宫阴道近距离放疗后筋膜外子宫切除术（第1组）或单纯根治性子宫切除术（第2组）治疗的早期宫颈癌患者的总生存期（OS）和无病生存期（DFS）。次要目标是比较这两种不同治疗方法的发病率，并评估接受根治性子宫切除术患者的宫旁组织受累率。
这是一项2001年至2013年间在保利·卡尔梅特研究所（马赛）和奥斯卡·兰布雷特中心（里尔）之间进行的回顾性合作研究，研究对象为国际妇产科联盟（FIGO）分期为IA1、IA2、IB1和IIA且直径小于2厘米、无盆腔淋巴结转移的肿瘤患者。
共纳入151例患者（第1组74例，第2组77例）。两组的人口统计学特征具有可比性。OS和DFS分别为92.3%对100%（p = 0.046）以及92.3%和98.7%（p = 0.18）。并发症发生率分别为12.2%和44.2%（p < 0.0001）。在第2组中，本研究的宫旁组织侵犯率为1.30%。
在我们的研究中，两种治疗策略在DFS方面具有可比性。并发症在第2组似乎更常见，但在第1组更严重。最后，第2组较低的宫旁组织侵犯率证实了在这些预后良好的分期中采用不太激进的手术治疗的益处。
