Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
Gynecol Oncol. 2020 Jul;158(1):92-98. doi: 10.1016/j.ygyno.2020.04.684. Epub 2020 May 4.
This study aims to investigate the survival impact of minimally invasive surgery on endometrial cancer (EC) patients with different histology and microsatellite status.
This is a retrospective study based on the Cancer Genome Atlas (TCGA) data. 519 eligible EC patients were divided into four subgroups according to histology and microsatellite status. Kaplan-Meier survival analyses were conducted in all patients and four subgroups to compare the survival outcome after two surgeries (open vs. minimally invasive). Propensity score matching and propensity score covariate adjustment models were used to control confounders. To establish survival prediction models for EC patients, multivariate stepwise Cox regressions were conducted.
Among the eligible patients, 318 (61.3%) received open surgery and 201 (38.7%) received minimally invasive surgery. Overall survival was similar between the two groups (p = 0.33), but the latter showed significantly shorter recurrence-free survival (RFS) (p = 0.005). Subgroup analyses revealed the survival influence of surgical approach was only significant in microsatellite-stable (MSS) endometrioid EC patients. These results were verified by Kaplan-Meier survival analyses after propensity score matching and propensity score covariate adjustment models. Finally, the survival influence of multiple clinicopathological factors was analyzed. After stepwise Cox regressions, minimally invasive surgery was found to be independent risk factor for shorter RFS of all patients (hazard ratio [HR] = 2.038, 95% confidence interval [CI] 1.111-3.741, p = 0.02) and MSS patients (HR = 2.449, 95% CI 1.064-5.639, p = 0.04).
Minimally invasive surgery is associated with more rapid recurrence in MSS endometrioid EC patients, thus indicating the necessity of microsatellite testing for guiding EC surgery.
本研究旨在探讨不同组织学和微卫星状态的子宫内膜癌（EC）患者微创治疗的生存影响。
这是一项基于癌症基因组图谱（TCGA）数据的回顾性研究。根据组织学和微卫星状态，将 519 名符合条件的 EC 患者分为四组。对所有患者和四组患者进行 Kaplan-Meier 生存分析，比较两种手术（开腹手术与微创手术）后的生存结局。采用倾向评分匹配和倾向评分协变量调整模型控制混杂因素。采用多变量逐步 Cox 回归建立 EC 患者的生存预测模型。
在合格患者中，318 例（61.3%）接受开腹手术，201 例（38.7%）接受微创手术。两组总生存率无差异（p=0.33），但后者无复发生存率（RFS）明显较短（p=0.005）。亚组分析显示，手术方式的生存影响仅在微卫星稳定（MSS）子宫内膜样 EC 患者中显著。这些结果通过倾向评分匹配和倾向评分协变量调整模型后的 Kaplan-Meier 生存分析得到验证。最后，分析了多个临床病理因素的生存影响。经逐步 Cox 回归分析，微创治疗被发现是所有患者（风险比[HR]=2.038，95%置信区间[CI]1.111-3.741，p=0.02）和 MSS 患者（HR=2.449，95%CI 1.064-5.639，p=0.04）RFS 较短的独立危险因素。
微创手术与 MSS 子宫内膜样 EC 患者更快的复发相关，因此表明需要进行微卫星检测以指导 EC 手术。
