Li Pengfei, Liu Ping, Yang Ying, Wang Lu, Liu Jiaqi, Bin Xiaonong, Lang Jinghe, Chen Chunlin
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University, Chongqing, China.
Front Oncol. 2020 Jul 8;10:1002. doi: 10.3389/fonc.2020.01002. eCollection 2020.
This study aimed to compare the 5-year disease-free survival (DFS) and overall survival (OS) of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for IA1 with lymphovascular space invasion (LVSI)-IIA2 cervical cancer and to analyze the Cox proportional hazard ratio (HR) of LRH among the total study population and different subgroups. This was a multicenter retrospective cohort study. The oncological outcomes of LRH ( = 4,236) and ARH ( = 9,177) were compared. The HRs and 95% confidence intervals for the effect of LRH on 5-year OS and DFS were estimated by Cox proportional hazards models. Overall, there was no difference in DFS between LRH and ARH in the unadjusted analysis (HR 1.11, 95% CI: 0.99-1.25, = 0.075). The risk-adjusted analysis revealed that LRH was independently associated with inferior DFS (HR 1.25, 95% CI: 1.11-1.40, < 0.001). There was no difference in OS between the two groups in the unadjusted analysis (HR 1.00, 95% CI: 0.85-1.17, = 0.997) or risk-adjusted analysis (HR 1.15, 95% CI: 0.98-1.35, = 0.091). For patients with FIGO stage IB1 and tumor size <2 cm, LRH was not associated with lower DFS or OS ( = 0.637 or = 0.107, respectively) in risk-adjusted analysis. For patients with FIGO stage IB1 and tumor size ≥2 cm, LRH was associated with lower 5-year DFS (HR 1.42, 95% CI: 1.19-1.69, < 0.001) in risk-adjusted analysis, but it was not associated with lower 5-year OS ( = 0.107). For patients with FIGO stage IIA1 and tumor size <2 cm, LRH was not associated with lower 5-year DFS or OS ( = 0.954 or = 0.873, respectively) in risk-adjusted analysis. For patients with FIGO stage IIA1 and tumor size ≥2 cm, LRH was associated with lower DFS (HR 1.48, 95% CI: 1.16-1.90, = 0.002) and 5-year OS (HR 1.69, 95% CI: 1.22-2.33, = 0.002) in risk-adjusted analysis. The 5-year DFS of LRH was worse than that of ARH for FIGO stage IA1 with LVSI-IIA2. LRH is not an appropriate option for FIGO stage IB1 or IIA1 and tumor size ≥ 2 cm compared with ARH.
本研究旨在比较腹腔镜根治性子宫切除术（LRH）与腹式根治性子宫切除术（ARH）治疗伴有脉管间隙浸润（LVSI）的IA1-IIA2期宫颈癌的5年无病生存率（DFS）和总生存率（OS），并分析LRH在整个研究人群及不同亚组中的Cox比例风险比（HR）。这是一项多中心回顾性队列研究。比较了LRH组（n = 4236）和ARH组（n = 9177）的肿瘤学结局。通过Cox比例风险模型估计LRH对5年OS和DFS影响的HR及95%置信区间。总体而言，在未校正分析中，LRH与ARH的DFS无差异（HR 1.11，95%CI：0.99 - 1.25，P = 0.075）。风险校正分析显示，LRH与较差的DFS独立相关（HR 1.25，95%CI：1.11 - 1.40，P < 0.001）。在未校正分析（HR 1.00，95%CI：0.85 - 1.17，P = 0.997）或风险校正分析（HR 1.15，95%CI：0.98 - 1.35，P = 0.091）中，两组的OS均无差异。对于国际妇产科联盟（FIGO）分期为IB1且肿瘤大小<2 cm的患者，在风险校正分析中，LRH与较低的DFS或OS无关（分别为P = 0.637或P = 0.107）。对于FIGO分期为IB1且肿瘤大小≥2 cm的患者，在风险校正分析中，LRH与较低的5年DFS相关（HR 1.42，95%CI：1.19 - 1.69，P < 0.001），但与较低的5年OS无关（P = 0.107）。对于FIGO分期为IIA1且肿瘤大小<2 cm的患者，在风险校正分析中，LRH与较低的5年DFS或OS无关（分别为P = 0.954或P = 0.873）。对于FIGO分期为IIA1且肿瘤大小≥2 cm的患者，在风险校正分析中，LRH与较低的DFS（HR 1.48，95%CI：1.16 - 1.90，P = 0.002）和5年OS（HR 1.69，95%CI：1.22 - 2.33，P = 0.002）相关。对于伴有LVSI的FIGO IA1-IIA2期患者，LRH的5年DFS比ARH差。与ARH相比，LRH不是FIGO IB1期或IIA1期且肿瘤大小≥2 cm患者的合适选择。
