Department of Obstetrics and Gynecology, Nan Fang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
Department of Obstetrics and Gynecology, Xinxiang Central Hospital, Henan, 453000, China.
Eur J Surg Oncol. 2021 Feb;47(2):346-352. doi: 10.1016/j.ejso.2020.07.016. Epub 2020 Jul 24.
To compare the 5-year overall survival (OS) and disease-free survival (DFS) rate of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for stage IIA1 cervical squamous cell carcinoma.
Based on a large database containing information on the clinical diagnosis and treatment of cervical cancer in China, the oncological outcomes of the two surgical approaches for stage IIA1 cervical squamous cell carcinoma were compared after 1:2 propensity score matching (PSM).
After 1:2 propensity score matching (PSM), 510 patients were included in the LRH group, and 999 patients were included in the ARH group. LRH showed a similar 5-year OS but a lower DFS rate (81.3% vs. 87.4%, P = 0.018) than ARH. In the multivariate analysis, LRH was identified as an independent risk factor for worse 5-year DFS (HR = 1.569, 95% CI: 1.131-2.176, P = 0.007). Among patients with a tumour size <2 cm, the LRH and ARH groups showed similar OS and DFS rates after 1:2 PSM, and multivariate analysis showed that the surgical approach was not an independent risk factor affecting the OS or DFS rate. Among patients with a tumour size ≥2 cm and <4 cm, there was no difference in OS between the LRH and ARH groups after matching, but the DFS in the LRH group was significantly lower than that in the ARH group (81.1% vs 86.2%, P = 0.034). In the multivariate analysis, the laparoscopic approach was not associated with OS but was independently associated with worse DFS (HR = 1.546, 95% CI: 1.094-2.185, P = 0.014).
LRH was associated with poorer 5-year DFS than ARH in patients with stage IIA1 cervical squamous cell carcinoma. However, LRH showed 5-year OS and DFS rates similar to those of ARH among patients with a tumour size <2 cm. For patients with a tumour size ≥2 cm and <4 cm, LRH showed a lower DFS rate than ARH.
比较腹腔镜根治性子宫切除术（LRH）与经腹根治性子宫切除术（ARH）治疗 IIA1 期宫颈鳞癌的 5 年总生存率（OS）和无病生存率（DFS）。
基于中国宫颈癌临床诊断和治疗的大型数据库，对两种手术方法治疗 IIA1 期宫颈鳞癌的肿瘤学结局进行了 1:2 倾向评分匹配（PSM）后比较。
经 1:2 倾向评分匹配（PSM）后，LRH 组纳入 510 例患者，ARH 组纳入 999 例患者。LRH 的 5 年 OS 相似，但 DFS 率较低（81.3%比 87.4%，P=0.018）。多因素分析显示，LRH 是 5 年 DFS 较差的独立危险因素（HR=1.569，95%CI：1.131-2.176，P=0.007）。在肿瘤直径<2cm 的患者中，LRH 和 ARH 组在 1:2 PSM 后 OS 和 DFS 率相似，多因素分析显示手术方式不是影响 OS 或 DFS 率的独立危险因素。在肿瘤直径≥2cm 且<4cm 的患者中，LRH 和 ARH 组之间的 OS 无差异，但 LRH 组的 DFS 明显低于 ARH 组（81.1%比 86.2%，P=0.034）。多因素分析显示，腹腔镜手术与 OS 无关，但与 DFS 较差相关（HR=1.546，95%CI：1.094-2.185，P=0.014）。
LRH 与 ARH 相比，IIA1 期宫颈鳞癌患者 5 年 DFS 较差。然而，在肿瘤直径<2cm 的患者中，LRH 的 5 年 OS 和 DFS 率与 ARH 相似。对于肿瘤直径≥2cm 且<4cm 的患者，LRH 的 DFS 率低于 ARH。
