腹腔镜手术与开腹手术治疗ⅠB2/ⅡA2 期宫颈癌根治术的生存结局比较。
Comparison of survival outcomes between laparoscopic surgery and abdominal surgery for radical hysterectomy as primary treatment in patients with stage IB2/IIA2 cervical cancer.
机构信息
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Department of Obstetrics and Gynecology, Research Institute of Surgery, Daping Hospital, the Third Military Medical University, Chongqing, China.
出版信息
J Obstet Gynaecol Res. 2021 Apr;47(4):1516-1526. doi: 10.1111/jog.14693. Epub 2021 Feb 1.
OBJECTIVE
To investigate the long-term oncological outcomes of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for the treatment of stage IB2/IIA2 cervical cancer without preoperative adjuvant therapy.
METHODS
We conducted a multicenter, retrospective, case-matching study. The differences in overall survival (OS) and disease-free survival (DFS) between the LRH and ARH were compared under the conditions of real-world study and case-control matching (1:1 matching).
RESULTS
There was no significant difference in the outcomes of LRH (n = 580) and ARH (n = 1653) in 5-year OS and DFS (OS: 80.6% vs. 86.1%, p = 0.421; DFS: 78.6% vs. 80.7%, p = 0.376). After 1:1 matching, there was no difference in 5-year OS and DFS between LRH (n = 554) and ARH (n = 554) (OS: 80.4% vs. 84.5%, p = 0.993; DFS: 79.0% vs. 78.8%, p = 0.695). Before and after matching, the surgical approach was not an independent risk factor for 5-year OS and DFS, and postoperative adjuvant therapy affected patient prognosis. Further subgroup analysis suggested that there was no difference in LRH (n = 313) and ARH (n = 1092) in 5-year OS or DFS in patients who underwent standard postoperative adjuvant therapy (OS: 83.0% vs. 87.7%, p = 0.992; DFS: 79.0% vs. 82.5%, p = 0.323). After 1:1 pairing, the 5-year OS and DFS in LRH (n = 295) and ARH (n = 295) showed no difference. Before and after matching, the surgical approach was not an independent risk factor affecting the 5-year OS and DFS.
CONCLUSIONS
There was no difference in the oncological outcomes between laparoscopic and abdominal surgery in patients with stage IB2/IIA2 cervical cancer without preoperative adjuvant therapy.
CLINICAL TRIALS
The ethical approval number is NFEC-2017-135, and the clinical research registration number is CHiCTR1800017778 (International Clinical Trials Registry Platform Search Port, http://apps.who.int/trialsearch/).
目的
研究无术前辅助治疗的 IB2/IIA2 期宫颈癌患者行腹腔镜根治性子宫切除术（LRH）与经腹根治性子宫切除术（ARH）的长期肿瘤学结局。
方法
我们进行了一项多中心、回顾性、病例匹配研究。在真实世界研究和病例对照匹配（1:1 匹配）的条件下，比较了 LRH（n=580）和 ARH（n=1653）的总生存（OS）和无病生存（DFS）差异。
结果
LRH（n=580）和 ARH（n=1653）在 5 年 OS 和 DFS 方面无显著差异（OS：80.6% vs. 86.1%，p=0.421；DFS：78.6% vs. 80.7%，p=0.376）。1:1 匹配后，LRH（n=554）和 ARH（n=554）的 5 年 OS 和 DFS 无差异（OS：80.4% vs. 84.5%，p=0.993；DFS：79.0% vs. 78.8%，p=0.695）。匹配前后，手术方式均不是 5 年 OS 和 DFS 的独立危险因素，术后辅助治疗影响患者预后。进一步亚组分析表明，标准术后辅助治疗的患者中，LRH（n=313）和 ARH（n=1092）的 5 年 OS 或 DFS 无差异（OS：83.0% vs. 87.7%，p=0.992；DFS：79.0% vs. 82.5%，p=0.323）。1:1 配对后，LRH（n=295）和 ARH（n=295）的 5 年 OS 和 DFS 无差异。匹配前后，手术方式均不是影响 5 年 OS 和 DFS 的独立危险因素。
结论
无术前辅助治疗的 IB2/IIA2 期宫颈癌患者，腹腔镜手术与开腹手术的肿瘤学结局无差异。
临床试验
伦理审批号为 NFEC-2017-135，临床研究注册号为 CHiCTR1800017778（国际临床试验注册平台检索号，http://apps.who.int/trialsearch/）。
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