Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Department of Gynaecological Oncology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, the Netherlands.
Eur J Cancer. 2020 Jul;133:14-21. doi: 10.1016/j.ejca.2020.04.006. Epub 2020 May 15.
Recently, the safety of laparoscopic radical hysterectomy (LRH) has been called into question in early-stage cervical cancer. This study aimed to evaluate overall survival (OS) and disease-free survival (DFS) in patients treated with abdominal radical hysterectomy (ARH) and LRH for early-stage cervical cancer and to provide a literature review.
Patients diagnosed between 2010 and 2017 with International Federation of Gynaecology and Obstetrics (2009) stage IA2 with lymphovascular space invasion, IB1 and IIA1, were identified from the Netherlands Cancer Registry. Cox regression with propensity score, based on inverse probability treatment weighting, was applied to examine the effect of surgical approach on 5-year survival and calculate hazard ratios (HR) and 95% confidence intervals (CIs). Literature review included observational studies with (i) analysis on tumours ≤4 cm (ii) median follow-up ≥30 months (iii) ≥5 events per predictor parameter in multivariable analysis or a propensity score.
Of the 1109 patients, LRH was performed in 33%. Higher mortality (9.4% vs. 4.6%) and recurrence (13.1% vs. 7.3%) were observed in ARH than LRH. However, adjusted analyses showed similar DFS (89.4% vs. 90.2%), HR 0.92 [95% CI: 0.52-1.60]) and OS (95.2% vs. 95.5%), HR 0.94 [95% CI: 0.43-2.04]). Analyses on tumour size (<2/≥2 cm) also gave similar survival rates. Review of nine studies showed no distinct advantage of ARH, especially in tumours <2 cm.
After adjustment, our retrospective study showed equal oncological outcomes between ARH and LRH for early-stage cervical cancer - also in tumours <2 cm. This is in correspondence with results from our literature review.
最近，腹腔镜根治性子宫切除术（LRH）在早期宫颈癌中的安全性受到质疑。本研究旨在评估接受腹式根治性子宫切除术（ARH）和 LRH 治疗的早期宫颈癌患者的总生存率（OS）和无病生存率（DFS），并进行文献复习。
从荷兰癌症登记处确定了 2010 年至 2017 年间国际妇产科联合会（2009 年）分期为 IA2 伴血管淋巴管间隙浸润、IB1 和 IIA1 的患者。采用基于逆概率治疗加权的 Cox 回归分析，检查手术方式对 5 年生存率的影响，并计算风险比（HR）和 95%置信区间（CI）。文献综述包括观察性研究，其中（i）分析肿瘤≤4cm（ii）中位随访时间≥30 个月（iii）多变量分析中每个预测参数的≥5 个事件或倾向评分。
在 1109 名患者中，LRH 占 33%。ARH 的死亡率（9.4% vs. 4.6%）和复发率（13.1% vs. 7.3%）均高于 LRH。然而，调整分析显示 DFS（89.4% vs. 90.2%）、HR 0.92（95%CI：0.52-1.60）和 OS（95.2% vs. 95.5%）、HR 0.94（95%CI：0.43-2.04）相似。肿瘤大小（<2/≥2cm）的分析也给出了相似的生存率。对 9 项研究的回顾显示，ARH 没有明显优势，尤其是在肿瘤<2cm 时。
在调整后，我们的回顾性研究显示，ARH 和 LRH 治疗早期宫颈癌的肿瘤学结果相等，包括肿瘤<2cm。这与我们的文献综述结果一致。
