Kong Tae-Wook, Son Joo-Hyuk, Paek Jiheum, Chang Suk-Joon, Ryu Hee-Sug
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
Eur J Obstet Gynecol Reprod Biol. 2020 Sep;252:94-99. doi: 10.1016/j.ejogrb.2020.06.030. Epub 2020 Jun 16.
The aim of this study was to evaluate the clinicopathologic factors influencing pelvic, extra-pelvic, and intraperitonal recurrences and survival in patients with lymph node-negative early-stage cervical cancer treated with abdominal/laparoscopic/robotic radical hysterectomy (ARH/LRH/RRH).
We retrospectively reviewed clinicopathologic data of 342 patients with FIGO stage IB-IIA cervical cancer (2018 FIGO staging) treated with RH and retroperitonal lymphadenectomy between February 2000 and November 2018. Several clinicopathologic factors such as surgical methods including LRH/RRH-vaginal colpotomy (VC) and LRH/RRH-intracorporeal colpotomy (IC), surgical resection margin, and parametrial/endomyometrial infiltration were selected. Univariate and multivariate Cox proportional hazard regression and logistic regression models were used to determine prognostic factors.
The median follow-up time was 54 months (range, 6-202 months). In multivariate analysis, positive endomyometrial infiltration (HR, 13.576; 95 % CI, 2.917-63.179; P = 0.001), positive parametrial resection margin (HR, 32.648; 95 % CI, 2.774-384.181; P = 0.006), and LRH/RRH-IC (HR, 4.752; 95 % CI, 1.154-19.578; P = 0.031) were significantly related to overall survival. Six (26.3 %) out of 21 patients with endomyometrial infiltration showed extra-pelvic recurrences associated with lung, liver, and brain. Three (50.0 %) out of 6 patients with positive parametrial margin showed both pelvic and extra-pelvic metastases, such as pelvis and supraclavicular/paratracheal lymph nodes. Five (62.5 %) out of the eight relapsed patients who received LRH/RRH-IC showed intraperitoneal recurrences including omentum, liver surface, colon serosa, and splenic hilum.
Three risk factors including parametrial margin, endomyometrial infiltration, and laparoscopic IC appear to be involved in pelvic, extra-pelvic, and intraperitoneal recurrences in node-negative early-stage cervical cancer patients following RH. In particular, endomyometrial infiltration may be one of the strongest independent prognostic factors for extra-pelvic recurrence. Adjuvant systemic therapy may be indicated for lymph node-negative early-stage cervical cancer patients with endomyometrial infiltration.
本研究旨在评估影响接受腹式/腹腔镜/机器人根治性子宫切除术（ARH/LRH/RRH）治疗的淋巴结阴性早期宫颈癌患者盆腔、盆腔外及腹腔内复发和生存的临床病理因素。
我们回顾性分析了2000年2月至2018年11月期间接受RH和腹膜后淋巴结清扫术治疗的342例FIGO IB-IIA期宫颈癌（2018年FIGO分期）患者的临床病理数据。选取了几个临床病理因素，如手术方法，包括LRH/RRH-经阴道子宫切除术（VC）和LRH/RRH-体内子宫切除术（IC）、手术切缘以及宫旁组织/子宫内膜浸润情况。采用单因素和多因素Cox比例风险回归模型及逻辑回归模型来确定预后因素。
中位随访时间为54个月（范围6 - 202个月）。在多因素分析中，子宫内膜浸润阳性（HR，13.576；95%CI，2.917 - 63.179；P = 0.001）、宫旁切缘阳性（HR，32.648；95%CI，2.774 - 384.181；P = 0.006）以及LRH/RRH-IC（HR，4.752；95%CI，1.154 - 19.578；P = 0.031）与总生存显著相关。21例子宫内膜浸润患者中有6例（26.3%）出现与肺、肝和脑相关的盆腔外复发。6例宫旁切缘阳性患者中有3例（50.0%）出现盆腔和盆腔外转移，如盆腔和锁骨上/气管旁淋巴结。接受LRH/RRH-IC的8例复发患者中有5例（62.5%）出现腹腔内复发，包括大网膜、肝表面、结肠浆膜和脾门。
宫旁切缘、子宫内膜浸润和腹腔镜IC这三个危险因素似乎与RH术后淋巴结阴性早期宫颈癌患者的盆腔、盆腔外及腹腔内复发有关。特别是，子宫内膜浸润可能是盆腔外复发最强的独立预后因素之一。对于有子宫内膜浸润的淋巴结阴性早期宫颈癌患者，可能需要辅助全身治疗。
