Int J Gynecol Cancer. 2018 May;28(4):757-763. doi: 10.1097/IGC.0000000000001228.
This study aimed to describe the pattern of recurrence and survival related to prognostic variables, including type of surgery as a clinical variable, in patients surgically treated for early cervix cancer.
Records of 2124 patients who underwent a radical hysterectomy for International Federation of Gynaecology and Obstetrics stage I/IIA cervical cancer between 1982 and 2011 were reviewed. Clinical-pathologic prognostic variables, also including extent of parametrectomy, were identified and used in a multivariable Cox proportional hazard model to explore associations between disease-free survival (DFS) and prognostic variables.
The 5-year DFS for the total group was 86%. Large tumor diameter, nonsquamous histology, lymph node metastases, parametrial involvement, lymph vascular space invasion, deep stromal invasion, and less radical surgery were independent poor prognostic variables for survival. Disease-free survival was independently associated with the type of radical hysterectomy with pelvic lymphadenectomy in favor of more radical parametrectomy (hazard ratio, 2.0; 95% confidence interval, 1.6-2.5). This difference was not found in tumors with a diameter of at least 20 mm.
This study confirms that variables such as large tumor diameter, nonsquamous histology, lymph vascular space invasion, deep stromal invasion, positive lymph nodes, and parametrial infiltration are poor prognostic variables in early cervix cancer treated by surgery. The extent of parametrectomy had no influence on survival in tumors of 20 mm or less. For larger tumors, a more radical hysterectomy might be associated with better DFS. Taking into account the possible bias in this study as a result of its retrospective design, ideally a prospective cohort study with clear definition of radicality is necessary to answer this important clinical question.
本研究旨在描述与预后变量相关的复发和生存模式，包括手术类型作为临床变量，在接受早期宫颈癌根治性子宫切除术治疗的患者中。
回顾了 1982 年至 2011 年间接受国际妇产科联合会（FIGO）Ⅰ/ⅡA 期宫颈癌根治性子宫切除术的 2124 例患者的病历。确定了临床病理预后变量，还包括广泛的宫旁切除术的范围，并在多变量 Cox 比例风险模型中使用这些变量来探讨无病生存（DFS）与预后变量之间的关系。
总组的 5 年 DFS 为 86%。大肿瘤直径、非鳞状组织学、淋巴结转移、宫旁侵犯、淋巴血管空间侵犯、深肌层浸润和不彻底的手术是生存的独立不良预后因素。DFS 与盆腔淋巴结切除术的根治性子宫切除术类型独立相关，有利于更广泛的宫旁切除术（风险比，2.0；95%置信区间，1.6-2.5）。在直径至少为 20mm 的肿瘤中未发现这种差异。
本研究证实，在接受手术治疗的早期宫颈癌中，大肿瘤直径、非鳞状组织学、淋巴血管空间侵犯、深肌层浸润、淋巴结阳性和宫旁浸润等变量是不良预后因素。宫旁切除术的范围对 20mm 或更小的肿瘤的生存没有影响。对于更大的肿瘤，更广泛的子宫切除术可能与更好的 DFS 相关。考虑到本研究由于其回顾性设计可能存在偏倚，理想情况下需要进行明确定义根治性的前瞻性队列研究来回答这个重要的临床问题。
