腹腔镜根治性子宫切除术与根治性腹式子宫切除术治疗早期宫颈癌的肿瘤学结局：一项多中心分析。

Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis.

机构信息

Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia.

Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia.

出版信息

Int J Gynecol Cancer. 2021 Apr;31(4):504-511. doi: 10.1136/ijgc-2020-002086. Epub 2021 Jan 27.

DOI:10.1136/ijgc-2020-002086

PMID:33504547

Abstract

INTRODUCTION

Recent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy.

METHODS

We performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models.

RESULTS

A total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8-201.2) in the laparoscopic group and 52.6 months (range, 0.4-166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09-2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05-4.37; P=0.03).

CONCLUSION

In this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.

摘要

介绍

最近的证据表明，在早期宫颈癌中使用微创手术会产生不良的肿瘤学结果。本研究的目的是比较行腹腔镜或剖腹根治性子宫切除术和盆腔淋巴结切除术的患者的无病生存率。

方法

我们对 2006 年 1 月 1 日至 2017 年 12 月 31 日期间在六个国家的七个癌症中心就诊的患有 FIGO 2009 分类的 IA1 伴淋巴血管侵犯、IA2 和 IB1 期宫颈癌的患者进行了多中心回顾性队列研究。包括鳞癌、腺癌和腺鳞癌。我们使用基于倾向评分的逆概率治疗加权法构建了一个加权队列，其中包括预先选择的预测变量，这些变量有可能影响手术方法与生存率之间的关系。我们使用加权 Cox 比例风险模型估计了根治性子宫切除术后全因死亡率的 HR。

结果

共有 1379 例患者纳入最终分析，其中 681 例（49.4%）接受腹腔镜手术，698 例（50.6%）接受剖腹手术。在阴道切缘阳性、深层间质浸润和淋巴管血管间隙浸润的发生率方面，手术方式无差异。腹腔镜组的中位随访时间为 52.1 个月（范围，0.8-201.2），剖腹组为 52.6 个月（范围，0.4-166.6）。与剖腹手术组相比，接受腹腔镜根治性子宫切除术的患者无病生存率较低（4 年率，88.7%比 93.0%；宫颈癌复发或死亡的 HR 为 1.64；95%CI 为 1.09-2.46；P=0.02）。在敏感性分析中，在调整辅助治疗后，与剖腹手术相比，腹腔镜根治性子宫切除术与宫颈癌复发或死亡的风险增加相关（HR 1.7；95%CI 为 1.13 至 2.57；P=0.01），与任何原因的死亡风险增加相关（HR 2.14；95%CI 为 1.05-4.37；P=0.03）。