Chen C L, Kang S, Chen B L, Yang Y, Guo J X, Hao M, Wang W L, Ji M, Sun L X, Wang L, Liang W T, Wang S G, Li W L, Fan H J, Liu P, Lang J H
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Department of Gynecology, Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China.
Zhonghua Fu Chan Ke Za Zhi. 2020 Sep 25;55(9):589-599. doi: 10.3760/cma.j.cn112141-20200515-00411.
To compare the long-term oncological outcomes between laparoscopic and abdominal surgery in stage Ⅰa1 （lymph-vascular space invasion-positive, LVSI）- Ⅰb1 cervical cancer patients with different tumor sizes. Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China (1538 project database), patients with stage Ⅰa1 （LVSI）-Ⅰb1 cervical cancer who treated by laparoscopic or abdominal surgery were included. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) between the two surgical approaches were compared under 1∶1 propensity score matching (PSM) in different tumor diameter stratification. (1) A total of 4 891 patients with stage Ⅰa1 （LVSI）-Ⅰb1 cervical cancer who underwent laparoscopy or laparotomy from January 1, 2009 to December 31, 2016 were included in the 1538 project database. Among them, 1 926 cases in the laparoscopic group and 2 965 cases in the abdominal group. There were no difference in 5-year OS and 5-year DFS between the two groups before matching. Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (=1.367, 95%: 1.105-1.690, =0.004). After 1∶1 PSM matching, 1 864 patients were included in each group, and there was no difference in 5-year OS between the two groups （94.1% vs 95.4%, =0.151）. While, the inferior 5-year DFS was observed in the laparoscopic group (89.0% vs 92.3%, =0.004). And the laparoscopic surgery was associated with lower 5-year DFS (=1.420, 95%: 1.109-1.818, =0.006). (2) In stratification analysis of different tumor sizes, and there were no difference in 5-year OS and 5-year DFS between the laparoscopic group and abdominal group in tumor size ≤1 cm, >1-2 cm and >2-3 cm stratification (all >0.05). Cox multivariate analysis showed that laparoscopic surgery were not related to 5-year OS and 5-year DFS (>0.05). In the stratification of tumor size >3-4 cm, there was no difference in 5-year OS between the two groups (>0.05). The 5-year DFS in the laparoscopic group was worse than that in the abdominal group (75.7% vs 85.8%, =0.025). Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (=1.705, 95%: 1.088-2.674, =0.020). For patients with stage Ⅰa1 （LVSI）-Ⅰb1 cervical cancer, laparoscopic surgery is associated with lower 5-year DFS, and the adverse effect of laparoscopic surgery on oncology prognosis is mainly reflected in patients with tumor size >3-4 cm. For patients with tumor sizes ≤1 cm, >1-2 cm and >2-3 cm, there are no difference in oncological prognosis between the two surgical approaches.
比较Ⅰa1期（淋巴血管间隙浸润阳性，LVSI）-Ⅰb1期不同肿瘤大小的宫颈癌患者行腹腔镜手术与开腹手术的长期肿瘤学结局。基于中国宫颈癌临床诊疗大数据库（1538项目数据库），纳入行腹腔镜手术或开腹手术治疗的Ⅰa1期（LVSI）-Ⅰb1期宫颈癌患者。在不同肿瘤直径分层下，采用1∶1倾向评分匹配（PSM）比较两种手术方式的5年总生存（OS）率和5年无病生存（DFS）率。（1）1538项目数据库纳入了2009年1月1日至2016年12月31日行腹腔镜手术或开腹手术的4891例Ⅰa1期（LVSI）-Ⅰb1期宫颈癌患者。其中，腹腔镜组1926例，开腹组2965例。匹配前两组的5年OS率和5年DFS率无差异。Cox多因素分析提示腹腔镜手术与较低的5年DFS率相关（=1.367，95%：1.105-1.690，=0.004）。1∶1 PSM匹配后，每组纳入1864例患者，两组的5年OS率无差异（94.1%对95.4%，=0.151）。然而，腹腔镜组的5年DFS率较低（89.0%对92.3%，=0.004）。且腹腔镜手术与较低的5年DFS率相关（=1.420，95%：1.109-1.818，=0.006）。（2）在不同肿瘤大小的分层分析中，肿瘤大小≤1 cm、>1-2 cm和>2-3 cm分层的腹腔镜组与开腹组的5年OS率和5年DFS率均无差异（均>0.05）。Cox多因素分析显示腹腔镜手术与5年OS率和5年DFS率无关（>0.05）。在肿瘤大小>3-4 cm的分层中，两组的5年OS率无差异（>0.05）。腹腔镜组的5年DFS率低于开腹组（75.7%对85.8%，=0.025）。Cox多因素分析提示腹腔镜手术与较低的5年DFS率相关（=1.705，95%：1.088-2.674，=0.
