Division of Urology, Department of Surgery, University of Toronto, Toronto.
Oncology and.
Int J Gynecol Cancer. 2018 Jun;28(5):989-995. doi: 10.1097/IGC.0000000000001266.
The treatment of cervical cancer can result in genitourinary morbidity. We measured selected urologic procedures after the treatment of cervical cancer with either surgery or radiation.
We used administrative data from the province of Ontario Canada to identify adult women who had nonmetastatic cervical cancer and were treated with surgery or radiation between 1994 and 2014. Study outcomes were surgical or procedure codes representing ureteric repair or fistula repair. Stress incontinence surgery, minimally invasive urologic procedures, open bowel/bladder surgeries, and secondary malignancy were measured to compare between treatment modalities. Multivariable Cox proportional hazards models were used.
Our final cohort consisted of 7311 women (median follow-up, 7.0 years [interquartile range, 2.9-13.3 years]), of which 3354 (44.9%) underwent radiation, and 3957 (54.1%) underwent surgery. After treatment of cervical cancer, ureteral repair was less common after surgery (3.4%) compared with radiation (10.3%) (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.19-0.32). Fistula repair was uncommon (0.9%) and occurred significantly more often in the surgery and radiation group compared with the radiation-alone group (HR, 4.02; 95% CI, 1.80-9.00). Overall, stress incontinence surgery was uncommon (2.2%) but was significantly more likely after surgery versus radiation (HR, 3.73; 95% CI, 2.13-6.53). Minimally invasive urologic procedures were less common after surgery compared with radiation (HR, 0.49; 95% CI, 0.44-0.54). Open bowel/bladder surgeries were similar among treatment modalities, and secondary malignancy was less common after treatment with surgery versus radiation (HR, 0.60; 95% CI, 0.39-0.92; P = 0.02).
Women treated for cervical cancer undergo ureteral stricture interventions at 0.8% per year over the 20 years after their treatment; this risk is higher among women who receive radiation treatment. Fistula repair is rare after cervical cancer.
宫颈癌的治疗可导致泌尿生殖系统发病率。我们评估了宫颈癌患者接受手术或放疗治疗后的部分泌尿科治疗方案。
我们利用加拿大安大略省的行政数据，识别出 1994 年至 2014 年间患有非转移性宫颈癌且接受手术或放疗治疗的成年女性。研究结果是代表输尿管修复或瘘管修复的手术或治疗方案代码。我们比较了治疗方式之间的压力性尿失禁手术、微创泌尿科手术、开放性肠/膀胱手术和继发恶性肿瘤。多变量 Cox 比例风险模型用于分析。
我们的最终队列由 7311 名女性组成（中位随访时间为 7.0 年[四分位距 2.9-13.3 年]），其中 3354 名（44.9%）接受了放疗，3957 名（54.1%）接受了手术。宫颈癌治疗后，手术组的输尿管修复（3.4%）明显低于放疗组（10.3%）（风险比[HR]，0.25；95%置信区间[CI]，0.19-0.32）。瘘管修复罕见（0.9%），且手术组与放疗组相比更为常见（HR，4.02；95%CI，1.80-9.00）。总的来说，压力性尿失禁手术少见（2.2%），但手术组明显高于放疗组（HR，3.73；95%CI，2.13-6.53）。微创泌尿科手术也明显少于手术组（HR，0.49；95%CI，0.44-0.54）。不同治疗方式之间的开放性肠/膀胱手术相似，手术组的继发恶性肿瘤也少于放疗组（HR，0.60；95%CI，0.39-0.92；P=0.02）。
宫颈癌治疗 20 年后，女性每年发生输尿管狭窄干预的风险为 0.8%；放疗组女性的风险更高。宫颈癌后瘘管修复罕见。
