Leipzig School of Radical Pelvic Surgery, University of Leipzig, Leipzig, Germany; Department of Gynecology and Obstetrics, University of Essen, Essen, Germany; Department of Gynecology and Obstetrics, Technical University of Munich, Munich, Germany.
Department of Gynecology and Obstetrics, University of Leipzig, Leipzig, Germany.
Lancet Oncol. 2019 Sep;20(9):1316-1326. doi: 10.1016/S1470-2045(19)30389-4. Epub 2019 Aug 2.
Previous findings from our centre suggest that carcinoma of the cervix propagates within ontogenetic cancer fields, tissue compartments defined by staged morphogenesis. We aimed to determine whether surgical treatment that accounts for stage-associated, ontogenetic cancer fields and their associated lymphoid tissues results in locoregional tumour control without the need for adjuvant radiotherapy.
We did the final clinical and histopathological evaluation of data from, the single-centre, observational, cohort study, the Leipzig School Mesometrial Resection Study. Patients of any age with stage IB1, IB2, IIA1, IIA2, or IIB cervical cancer (according to 2009 International Federation of Gynecology and Obstetrics [FIGO]) had total mesometrial resection or extended mesometrial resection and therapeutic lymph node dissection, done on the basis of ontogenetic cancer fields. We defined sentinel node, first-line, second-line, and third-line lymph node regions as progressive regional cancer fields. Primary outcomes were disease-specific survival and recurrence-free survival, and treatment-related morbidity (assessed with the Franco-Italian glossary). Applying Cox proportional hazard models, ontogenetic local (T) and regional (N) tumour staging was compared with pathological T and N staging. This trial is registered with the German Clinical Trials Register, number DRKS00015171.
Between Oct 16, 1999, and June 27, 2017, 523 patients were treated per protocol and followed up for a median of 61·8 months (IQR 49·3-94·8). In 495 patients with cervical cancer treated with cancer field surgery, 5-year disease-specific survival was 89·4% (95% CI 86·5-92·4) and recurrence-free survival was 83·1% (79·7-86·6). In the per-protocol population of 523 patients, treatment-related morbidity comprised 112 (21%) grade 2 and 15 (3%) grade 3 complications. The most common moderate and severe treatment-related complications and sequelae were wound dehiscence (17 [3%]), hydronephrosis (17 [3%]), bowel obstruction (26 [5%]), and lymph oedema (33 [6%]). One patient (<1%), who received total mesometrial resection, died from postoperative brain infarction.
Total or extended mesometrial resection with therapeutic lymph node dissection based on ontogenetic cancer fields results in good survival outcomes of patients with cervical cancer in our institution, but needs to be investigated further in multicentre trials.
Leipzig School of Radical Pelvic Surgery, University of Leipzig Medical School, and the Gynecologic Oncology Research Foundation.
我们中心的先前研究结果表明，宫颈癌在胚胎发生癌场内传播，胚胎发生癌场是由分期形态发生定义的组织隔室。我们旨在确定是否手术治疗考虑到与阶段相关的、胚胎发生的癌场及其相关的淋巴组织，可以在不需要辅助放疗的情况下实现局部肿瘤控制。
我们对单中心观察性队列研究——莱比锡学校中胚层切除术研究的数据进行了最终的临床和组织病理学评估。任何年龄的 IB1、IB2、IIA1、IIA2 或 IIB 期宫颈癌（根据 2009 年国际妇产科联合会[FIGO]分期）患者均接受全中胚层切除术或扩展中胚层切除术和治疗性淋巴结清扫术，这些手术基于胚胎发生癌场进行。我们将前哨淋巴结、一线、二线和三线淋巴结区域定义为进展性局部癌场。主要结局是疾病特异性生存和无复发生存，以及与治疗相关的发病率（采用 Franco-Italian 词汇表评估）。应用 Cox 比例风险模型，胚胎发生局部（T）和区域（N）肿瘤分期与病理 T 和 N 分期进行比较。该试验在德国临床试验注册中心注册，注册号为 DRKS00015171。
在 1999 年 10 月 16 日至 2017 年 6 月 27 日期间，根据方案治疗了 523 名患者，并进行了中位 61.8 个月（IQR 49.3-94.8）的随访。在 495 名接受癌场手术治疗的宫颈癌患者中，5 年疾病特异性生存率为 89.4%（95%CI 86.5-92.4），无复发生存率为 83.1%（79.7-86.6）。在 523 名按方案治疗的患者中，与治疗相关的发病率包括 112 例（21%）2 级和 15 例（3%）3 级并发症。最常见的中度和重度治疗相关并发症和后遗症是伤口裂开（17 例[3%]）、肾盂积水（17 例[3%]）、肠梗阻（26 例[5%]）和淋巴水肿（33 例[6%]）。1 名患者（<1%）接受全中胚层切除术，死于术后脑梗死。
基于胚胎发生癌场的全中胚层切除术或扩展中胚层切除术联合治疗性淋巴结清扫术可使本机构宫颈癌患者获得良好的生存结局，但仍需在多中心试验中进一步研究。
莱比锡根治性骨盆手术学院、莱比锡医科大学和妇科肿瘤研究基金会。
