Department of Gynecology and Obstetrics (Drs. Smith, Jones, Miao, and Fader), Johns Hopkins School of Medicine, Baltimore, Maryland.
Department of Gynecology and Obstetrics (Drs. Smith, Jones, Miao, and Fader), Johns Hopkins School of Medicine, Baltimore, Maryland.
J Minim Invasive Gynecol. 2021 Mar;28(3):544-555.e7. doi: 10.1016/j.jmig.2020.12.023. Epub 2020 Dec 24.
To compare recurrence rate, progression-free survival (PFS), and overall survival for early-stage cervical cancer after minimally invasive (MIS) vs abdominal radical hysterectomy.
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Library databases.
We identified studies from 1990 to 2020 that included women with stage I or higher cervical cancer treated with primary radical hysterectomy and compared recurrence and/or PFS and overall survival with MIS vs abdominal radical hysterectomy. (The review protocol was registered with the International Prospective Register of Systematic Reviews: CRD4202173600).
TABULATION, INTEGRATION, AND RESULTS: We performed random-effects meta-analyses overall and by length of follow-up. Fifty articles on 40 cohort studies and 1 randomized controlled trial that included 22 593 women with cervical cancer met the inclusion criteria. Twenty percent of the studies had <36 months of follow-up, and 24% had more than 60 months of follow-up. The odds of PFS were worse for women undergoing MIS radical hysterectomy (odds ratio 1.54; 95% CI [confidence interval], 1.24-1.94; 14 studies). When limited to studies with longer follow-up, the odds of PFS were progressively worse with MIS radical hysterectomy (HR [hazard ratio] 1.48 for >36 months; 95% CI, 1.21-1.82; 10 studies; HR 1.69 for >48 months; 95% CI, 1.26-2.27; 5 studies; and HR 2.020 for >60 months; 95% CI, 1.36-3.001; 3 studies). For overall survival, the odds were not significantly different for MIS vs abdominal hysterectomy (odds ratio 0.94; 95% CI, 0.66-1.35; 14 studies) (HR 0.99 for >36 months; 95% CI, 0.66-1.48; 9 studies; HR 1.05 for >48 months; 95% CI, 0.57-1.94; 4 studies; and HR 1.35 for >60 months; 95% CI, 0.73-2.51; 3 studies).
In our meta-analysis of 50 studies, MIS radical hysterectomy was associated with worse PFS than open radical hysterectomy for early-stage cervical cancer. The emergence of this finding with longer follow-up highlights the importance of long-term, high-quality studies to guide cancer and surgical treatments.
比较微创（MIS）与经腹根治性子宫切除术治疗早期宫颈癌的复发率、无进展生存期（PFS）和总生存期。
MEDLINE、Embase、Cochrane 对照试验中心注册库和 Cochrane 图书馆数据库。
我们从 1990 年至 2020 年确定了纳入接受原发性根治性子宫切除术治疗的 I 期或更高期宫颈癌女性的研究，并比较了 MIS 与经腹根治性子宫切除术治疗的复发和/或 PFS 及总生存期。（该综述方案已在国际前瞻性系统评价注册库（CRD4202173600）中注册）。
表格制作、整合与结果：我们对总体和随访时间进行了随机效应荟萃分析。50 篇关于 40 项队列研究和 1 项随机对照试验的文章纳入了 22593 名宫颈癌女性，符合纳入标准。20%的研究随访时间<36 个月，24%的研究随访时间超过 60 个月。MIS 根治性子宫切除术患者的 PFS 结局较差（比值比 1.54；95%置信区间[CI]，1.24-1.94；14 项研究）。当仅限于随访时间较长的研究时，MIS 根治性子宫切除术的 PFS 结局逐渐恶化（HR [风险比]，>36 个月时为 1.48；95%CI，1.21-1.82；10 项研究；HR，>48 个月时为 1.69；95%CI，1.26-2.27；5 项研究；HR，>60 个月时为 2.020；95%CI，1.36-3.001；3 项研究）。对于总生存期，MIS 与经腹子宫切除术的结局无显著差异（比值比 0.94；95%CI，0.66-1.35；14 项研究）（HR，>36 个月时为 0.99；95%CI，0.66-1.48；9 项研究；HR，>48 个月时为 1.05；95%CI，0.57-1.94；4 项研究；HR，>60 个月时为 1.35；95%CI，0.73-2.51；3 项研究）。
在对 50 项研究的荟萃分析中，与开放式根治性子宫切除术相比，MIS 根治性子宫切除术与早期宫颈癌患者的 PFS 较差有关。随着随访时间的延长，这一发现的出现凸显了长期、高质量研究的重要性，这些研究有助于指导癌症和手术治疗。
