Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America.
PLoS One. 2019 Jan 7;14(1):e0210125. doi: 10.1371/journal.pone.0210125. eCollection 2019.
To examine clinico-pathological factors associated with surgical complications and postoperative therapy for clinical stage IB-IIB cervical cancer.
This nationwide multicenter retrospective study examined women with clinical stage IB-IIB cervical cancer who underwent radical hysterectomy plus pelvic and/or para-aortic lymphadenectomy between 2008-2009 at 87 institutions of the Japanese Gynecologic Oncology Group (n = 693). Multivariate models were used to identify independent predictors of perioperative grade 3-4 complications and bladder dysfunction.
The overall intraoperative and postoperative complication rates were 3.3% and 9.8%, respectively. Clinical stage was not associated with perioperative complications (P = 0.15). Radiotherapy-based adjuvant therapy was significantly associated with an increased risk of postoperative complications (radiotherapy alone: adjusted-odds ratio [OR] 3.19, 95% confidence interval [CI] 1.46-6.99, P = 0.004; radiotherapy plus chemotherapy: adjusted-OR 3.26, 95%CI 1.66-6.41, P = 0.001), whereas chemotherapy was not (P = 0.45). Nerve-sparing surgery significantly reduced the risk of postoperative bladder dysfunction (adjusted-OR 0.57, 95%CI 0.37-0.90, P = 0.02) whereas adjuvant chemotherapy increased the risk of bladder dysfunction (adjusted-OR 2.06, 95%CI 1.16-3.67, P = 0.01). Among women receiving adjuvant chemotherapy, nerve-sparing radical hysterectomy significantly reduced the risk of bladder dysfunction (15.0% versus 32.9%, OR 0.31, 95%CI 0.14-0.68, P = 0.004). After propensity score matching, survival outcomes were similar with both types of adjuvant therapy (radiotherapy-based versus chemotherapy, P>0.05).
Our study highlighted two distinct complication profiles of adjuvant therapy after radical hysterectomy for clinical stage IB-IIB cervical cancer, with radiotherapy increasing grade 3-4 adverse events and chemotherapy increasing bladder dysfunction. In this setting, nerve-sparing surgery may be useful if chemotherapy is being considered for adjuvant therapy.
研究与临床 IB 期-IIB 期宫颈癌根治性子宫切除术加盆腔和/或腹主动脉旁淋巴结清扫术相关的围手术期并发症及术后治疗的临床病理因素。
本项全国多中心回顾性研究纳入了 2008-2009 年在日本妇科肿瘤学组 87 个机构接受根治性子宫切除术加盆腔和/或腹主动脉旁淋巴结清扫术的临床 IB 期-IIB 期宫颈癌患者（n=693）。采用多变量模型确定围手术期 3-4 级并发症和膀胱功能障碍的独立预测因素。
总体术中及术后并发症发生率分别为 3.3%和 9.8%。临床分期与围手术期并发症无关（P=0.15）。基于放疗的辅助治疗与术后并发症风险增加显著相关（单纯放疗：校正优势比[OR]3.19，95%置信区间[CI]1.46-6.99，P=0.004；放疗联合化疗：校正 OR 3.26，95%CI 1.66-6.41，P=0.001），而化疗则不然（P=0.45）。保留神经的手术显著降低术后膀胱功能障碍的风险（校正 OR 0.57，95%CI 0.37-0.90，P=0.02），而辅助化疗则增加了膀胱功能障碍的风险（校正 OR 2.06，95%CI 1.16-3.67，P=0.01）。在接受辅助化疗的女性中，保留神经的根治性子宫切除术显著降低了膀胱功能障碍的风险（15.0%与 32.9%，OR 0.31，95%CI 0.14-0.68，P=0.004）。在倾向评分匹配后，两种辅助治疗的生存结果相似（基于放疗与化疗，P>0.05）。
本研究强调了根治性子宫切除术后辅助治疗的两种不同的并发症类型，放疗增加 3-4 级不良事件，化疗增加膀胱功能障碍。在这种情况下，如果考虑辅助化疗，保留神经的手术可能是有用的。
