接受次广泛子宫切除术的Ⅰ期子宫内膜癌女性患者的预后。
Prognosis of women with apparent stage I endometrial cancer who had supracervical hysterectomy.
作者信息
Matsuo Koji, Machida Hiroko, Takiuchi Tsuyoshi, Garcia-Sayre Jocelyn, Yessaian Annie A, Roman Lynda D
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
出版信息
Gynecol Oncol. 2017 Apr;145(1):41-49. doi: 10.1016/j.ygyno.2017.02.004. Epub 2017 Feb 17.
OBJECTIVE
To examine characteristics and survival outcomes of women with apparent early-stage endometrial cancer who had a supracervical hysterectomy.
METHODS
The Surveillance, Epidemiology, and End Results Program was used to identify women with presumed stage I endometrial cancer who underwent supracervical hysterectomy between 1983 and 2012. Propensity score matching was performed to adjust background difference between supracervical hysterectomy (n=1,339) and total hysterectomy (n=110,523) cases. Endometrial cancer-specific survival (CSS) was examined by multivariable analysis expressed with adjusted-hazard ratio [HR] and 95% confidence interval [CI].
RESULTS
Supracervical hysterectomy was independently associated with younger age, low-grade disease, and small tumor size on multivariable analysis (all, P<0.001). After propensity score matching, supracervical hysterectomy remained an independent prognostic factor for decreased CSS compared to total hysterectomy (10-year rates, 91.0% versus 94.9%, adjusted-HR 1.72, 95%CI 1.20-2.47, P=0.003). Among women who received postoperative radiotherapy, 10-year CSS rates were similar between supracervical and total hysterectomy cases (84.7% versus 80.3%, P=0.40). Contrary, in the absence of postoperative radiotherapy, women undergoing supracervical hysterectomy had a significantly lower 10-year CSS rate compared to those undergoing total hysterectomy (92.1% versus 97.2%, P<0.001). Moreover, with lack of lymphadenectomy, supracervical hysterectomy was associated with decreased CSS compared to those who had total hysterectomy (91.6% versus 94.3%, P=0.018) but had similar CSS rates with lymphadenectomy (92.7% versus 91.8%, P=0.91).
CONCLUSION
Although rarely performed, supracervical hysterectomy is associated with decreased survival outcome among women with apparent stage I endometrial cancer supporting the importance of avoiding this procedure in women with or at risk of endometrial cancer.
目的
研究接受次全子宫切除术的早期子宫内膜癌女性的特征及生存结局。
方法
利用监测、流行病学和最终结果计划来识别1983年至2012年间接受次全子宫切除术的疑似I期子宫内膜癌女性。进行倾向评分匹配以调整次全子宫切除术（n = 1339）和全子宫切除术（n = 110523）病例之间的背景差异。通过多变量分析以调整后的风险比[HR]和95%置信区间[CI]来检验子宫内膜癌特异性生存（CSS）情况。
结果
多变量分析显示，次全子宫切除术与年龄较轻、疾病分级较低和肿瘤较小独立相关（均P<0.001）。倾向评分匹配后，与全子宫切除术相比，次全子宫切除术仍是CSS降低的独立预后因素（10年生存率，91.0%对94.9%，调整后HR 1.72，95%CI 1.20 - 2.47，P = 0.003）。在接受术后放疗的女性中，次全子宫切除术和全子宫切除术病例的10年CSS率相似（84.7%对80.3%，P = 0.40）。相反，在没有术后放疗的情况下，接受次全子宫切除术的女性10年CSS率显著低于接受全子宫切除术的女性（92.1%对97.2%，P<0.001）。此外，在未进行淋巴结清扫的情况下，与接受全子宫切除术的女性相比，次全子宫切除术与CSS降低相关（91.6%对94.3%，P = 0.018），但在进行淋巴结清扫时CSS率相似（92.7%对91.8%，P = 0.91）。
结论
尽管次全子宫切除术很少进行，但对于疑似I期子宫内膜癌女性，其与生存结局降低相关，这支持了对于患有或有子宫内膜癌风险的女性避免该手术的重要性。
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