机器人根治性子宫切除术治疗早期宫颈癌的生存结局与机构学习曲线相关：一项回顾性研究。
The institutional learning curve is associated with survival outcomes of robotic radical hysterectomy for early-stage cervical cancer-a retrospective study.
机构信息
Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Gyeonggi-do, 446-916, South Korea.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Severance Hospital, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
出版信息
BMC Cancer. 2020 Feb 24;20(1):152. doi: 10.1186/s12885-020-6660-7.
BACKGROUND
Despite recent advances in diagnosis and treatment, cervical cancer continues to be a significant health problem worldwide. Whereas robot-assisted surgery has advantages over the abdominal approach, and minimally invasive techniques are being used increasingly, these may be associated with a higher recurrence rate and lower overall survival than the abdominal approach. The objective of this study was to compare the surgical and survival outcomes between abdominal radical hysterectomy (ARH) and robotic radical hysterectomy (RRH).
METHODS
A retrospective cohort of patients undergoing radical hysterectomy for cervical cancer from 2006 to 2018 was identified. Patients with stage IA to IB cervical cancer were included and grouped: ARH vs. RRH. The RRH group was further divided into two groups based on the year of enrollment: RRH1 (2006-2012) and RRH2 (2013-2018). Tumor characteristics, recurrence rate, progression-free survival (PFS), and overall survival (OS) were compared between the groups. P-values < 0.05 (two-sided) were considered statistically significant.
RESULTS
A total of 310 patients were identified: 142 and 168 underwent ARH and RRH, respectively. RRH1 and RRH2 had 77 and 91 patients, respectively. Interestingly, RRH2 was more likely to have a larger tumor size (1.7 ± 1.4 vs. 2.0 ± 1.1 vs. 2.4 ± 1.7 cm, P = 0.014) and higher stage (P < 0.001) than RRH1. However, RRH2 showed significantly favorable PFS in contrast to RRH1. There was no difference between ARH and RRH2 in PFS (P = 0.629), whereas overall, the RRH group showed significantly shorter PFS than the ARH group. In the multivariate analysis, the institutional learning curve represented by the operation year was one of the significant predictors for PFS (hazard ratio [HR] 0.065, P = 0.0162), along with tumor size (HR 5.651, P = 0.0241).
CONCLUSIONS
The institutional learning curve, represented by the operation year, is one of the most significant factors associated with outcomes of RRH for early-stage cervical cancer.
背景
尽管在诊断和治疗方面取得了新的进展，但宫颈癌仍然是全球一个重大的健康问题。虽然机器人辅助手术优于经腹手术，且微创手术的应用日益广泛，但与经腹手术相比，这些手术可能与更高的复发率和更低的总生存率相关。本研究旨在比较根治性子宫切除术（ARH）和机器人根治性子宫切除术（RRH）的手术和生存结局。
方法
回顾性纳入 2006 年至 2018 年接受宫颈癌根治性子宫切除术的患者队列。纳入局限于 IA 期至 IB 期宫颈癌患者，并将其分为 ARH 组和 RRH 组。RRH 组根据入组年份进一步分为 RRH1 组（2006-2012 年）和 RRH2 组（2013-2018 年）。比较两组患者的肿瘤特征、复发率、无进展生存期（PFS）和总生存期（OS）。P 值<0.05（双侧）被认为具有统计学意义。
结果
共纳入 310 例患者：ARH 组和 RRH 组分别为 142 例和 168 例。RRH1 组和 RRH2 组分别为 77 例和 91 例。有趣的是，RRH2 组的肿瘤大小（1.7±1.4 比 2.0±1.1 比 2.4±1.7cm，P=0.014）和分期（P<0.001）均高于 RRH1 组。然而，RRH2 组的 PFS 明显优于 RRH1 组。RRH2 组与 ARH 组的 PFS 无差异（P=0.629），而总体而言，RRH 组的 PFS 明显短于 ARH 组。多因素分析显示，以手术年份为代表的机构学习曲线是影响 PFS 的显著预测因素之一（风险比[HR]0.065，P=0.0162），此外，肿瘤大小（HR 5.651，P=0.0241）也是影响 PFS 的重要因素。
结论
以手术年份为代表的机构学习曲线是影响早期宫颈癌患者行 RRH 手术结局的最重要因素之一。
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