Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
Surg Oncol. 2020 Sep;34:7-12. doi: 10.1016/j.suronc.2020.02.015. Epub 2020 Feb 17.
To evaluate the prevalence and outcomes of minimally invasive surgery for stage I high grade endometrial cancer. We hypothesized that route of surgery is not associated with survival.
Patients diagnosed between 2010 and 2014, with stage I grade 3 endometrioid, serous, clear cell and carcinosarcoma endometrial carcinoma, who underwent hysterectomy with lymphadenectomy were drawn from the National Cancer Database. Patients converted to open surgery were excluded. Overall survival was assessed with Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to control for confounders.
A total of 12852 patients were identified. The rate of minimally invasive surgery was 62.2%. An increase in the use between 2010 and 2014 was noted (p < 0.001). Open surgery was associated with longer hospital stay (median 3 vs 1 day, p < 0.001), higher 30-day unplanned re-admission rate (4.5% vs 2.4%, p < 0.001) and 30-day mortality (0.6% vs 0.3%, p = 0.008). There was no difference in overall survival between patients who had open or minimally invasive surgery, p = 0.22; 3-yr overall survival rates were 83.7% and 84.4% respectively. After controlling for patient age, tumor histology, substage, type of insurance, type of reporting facility, receipt of radiation therapy and chemotherapy, extent of lymphadenectomy, the presence of comorbidities and personal history of another tumor, minimally invasive surgery was not associated with a worse survival (hazard ratio: 1.06, 95% confidence interval: 0.97, 1.15).
Minimally invasive surgery for patients with stage I high grade endometrial cancer, was associated with superior short-term outcomes with no difference in overall survival noted.
评估Ⅰ期高级别子宫内膜癌微创手术的流行率和结果。我们假设手术途径与生存率无关。
从国家癌症数据库中抽取了 2010 年至 2014 年间诊断为Ⅰ期 3 级子宫内膜样癌、浆液性癌、透明细胞癌和癌肉瘤的行子宫切除术和淋巴结切除术的患者。排除了转换为开放手术的患者。采用 Kaplan-Meier 曲线评估总生存率，并与对数秩检验进行比较。构建 Cox 模型以控制混杂因素。
共确定了 12852 例患者。微创手术率为 62.2%。2010 年至 2014 年间使用率增加（p<0.001）。开放手术与住院时间较长相关（中位数 3 天比 1 天，p<0.001）、30 天非计划性再入院率较高（4.5%比 2.4%，p<0.001）和 30 天死亡率较高（0.6%比 0.3%，p=0.008）。开放手术和微创手术患者的总生存率无差异，p=0.22；3 年总生存率分别为 83.7%和 84.4%。在控制患者年龄、肿瘤组织学、亚分期、保险类型、报告机构类型、接受放疗和化疗、淋巴结清扫程度、合并症存在情况和另一种肿瘤个人史后，微创手术与生存率较差无关（风险比：1.06，95%置信区间：0.97，1.15）。
Ⅰ期高级别子宫内膜癌患者行微创手术与短期预后较好相关，总生存率无差异。
