Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Center for Precision Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Gynecol Oncol. 2019 Oct;155(1):75-82. doi: 10.1016/j.ygyno.2019.07.019. Epub 2019 Aug 2.
To compare survival outcomes of primary laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in patients with FIGO stage IB cervical cancer.
We retrospectively identified stage IB1-IB2 cervical cancer patients who received either LRH (n = 343) or ORH (n = 222) at two tertiary institutional hospitals between 2000 and 2018. To adjust for confounders, we conducted Mahalanobis distance-based sample matching for stage, histology, cervical mass size, parametrial invasion, and lymph node metastasis. Then, survival outcomes were compared between the matched groups. Through the independent matching processes, we narrowed the study population to stage IB1 patients and stage IB1 patients with tumor size ≤2 cm on pre-operative MRI.
After matching, LRH group showed poorer progression-free survival (PFS) than ORH group (3-year: 85.4% vs. 91.8%; P = 0.036), whereas no significant difference in overall survival (OS) was found. Regarding recurrence patterns, no significant differences in the incidences of pelvic, retroperitoneal lymph node and abdominal recurrences, or distant metastasis were observed between the two groups. Among the matched patients with stage IB1 who had cervical mass size ≤2 cm, the LRH and ORH groups showed similar PFS (3-year: 90.0% vs. 93.1%; P = 0.8) and OS (5-year: 98.6% vs. 96.4%; P = 0.6).
Despite the retrospective design, our matched cohort study suggests that ORH might be preferable for the surgical treatment of FIGO stage IB cervical cancer. However, in stage IB1 patients with tumor size ≤2 cm, LRH might be applicable, as equivalent outcomes were found regardless of the surgical approach. Further prospective studies are warranted.
比较 FIGO 分期 IB 期宫颈癌患者行腹腔镜根治性子宫切除术（LRH）与开腹根治性子宫切除术（ORH）的生存结局。
本研究回顾性分析了 2000 年至 2018 年期间在两家三级医疗机构接受 LRH（n=343）或 ORH（n=222）治疗的 IB1-IB2 期宫颈癌患者。为了调整混杂因素，我们对分期、组织学、宫颈肿块大小、宫旁侵犯和淋巴结转移进行了马哈拉诺比斯距离基于样本匹配。然后，比较了匹配组之间的生存结局。通过独立的匹配过程，我们将研究人群缩小至 IB1 期患者和术前 MRI 肿瘤大小≤2cm 的 IB1 期患者。
匹配后，LRH 组的无进展生存期（PFS）明显劣于 ORH 组（3 年：85.4% vs. 91.8%；P=0.036），而总生存期（OS）无显著差异。关于复发模式，两组患者的盆腔、腹膜后淋巴结和腹部复发或远处转移的发生率无显著差异。在匹配的 IB1 期且宫颈肿块大小≤2cm 的患者中，LRH 组和 ORH 组的 PFS（3 年：90.0% vs. 93.1%；P=0.8）和 OS（5 年：98.6% vs. 96.4%；P=0.6）相似。
尽管本研究为回顾性设计，但我们的匹配队列研究表明，对于 FIGO 分期 IB 期宫颈癌，ORH 可能是更好的手术治疗选择。然而，对于肿瘤大小≤2cm 的 IB1 期患者，LRH 可能适用，因为无论手术方式如何，结局相当。需要进一步的前瞻性研究。
