Department of Gynecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.
Arch Gynecol Obstet. 2022 Jan;305(1):215-222. doi: 10.1007/s00404-021-06145-0. Epub 2021 Jul 21.
To evaluate association of preoperative cone biopsy with the probability of recurrent disease after radical hysterectomy for cervical cancer.
This is a retrospective single-center study. Patients with cervical cancer stage IA1 with LVSI to IIA2 and squamous, adenosquamous and adenocarcinoma subtype were included. Patients were analyzed for general characteristics and recurrence-free survival (RFS).
In total, of 480 patients with cervical cancer, 183 patients met the inclusion criteria (117 with laparoscopic and 66 with open surgery). The median tumor diameter was 25.0 mm (range 4.6-70.0 mm) with 66 (36.2%) patients having tumors smaller than 2 cm. During median follow-up of 54.0 months (range 0-166.0 months), the RFS for the laparoscopic cohort was 93.2% and 87.5% at 3 and 4.5 years, and 79.3% for the open cohort after 3 and 4.5 years, respectively. In total, 17 (9.3%) patients developed recurrent disease, 9 (7.3%) after laparoscopic, and 8 (12.1%) after open surgery. No preoperative cone biopsy (OR 9.60, 95% CI 2.14-43.09) as well as tumor diameter > 2 cm (OR 5.39, 95% CI 1.20-24.25) were significantly associated with increased risk for recurrence. In multivariate analysis, only missing preoperative cone biopsy was significantly associated with increased risk for recurrence (OR 5.90, 95% CI 1.11-31.29) CONCLUSION: There appears to be a subgroup of patients (preoperative cone biopsy, tumor diameter < 2 cm) with excellent survival and low risk for recurrence after radical hysterectomy which might benefit from the advantages of laparoscopic surgery.
评估术前宫颈锥切术与宫颈癌根治性子宫切除术后疾病复发的概率之间的关联。
这是一项回顾性单中心研究。纳入了 IA1 期伴有 LVSI 至 IIA2 期且为鳞癌、腺鳞癌和腺癌亚型的宫颈癌患者。分析患者的一般特征和无复发生存率（RFS）。
在总共 480 例宫颈癌患者中，有 183 例符合纳入标准（117 例行腹腔镜手术，66 例行开腹手术）。肿瘤的中位直径为 25.0mm（范围 4.6-70.0mm），其中 66 例（36.2%）患者的肿瘤直径小于 2cm。在中位随访 54.0 个月（范围 0-166.0 个月）期间，腹腔镜组的 RFS 分别为 93.2%和 87.5%，3 年和 4.5 年时分别为 79.3%，开腹组分别为 3 年和 4.5 年时分别为 9.3%和 8.1%。总共有 17 例（9.3%）患者出现复发疾病，9 例（7.3%）发生在腹腔镜手术后，8 例（12.1%）发生在开腹手术后。术前无宫颈锥切术（OR 9.60，95%CI 2.14-43.09）以及肿瘤直径>2cm（OR 5.39，95%CI 1.20-24.25）与复发风险增加显著相关。在多变量分析中，只有缺失术前宫颈锥切术与复发风险增加显著相关（OR 5.90，95%CI 1.11-31.29）。
似乎有一小部分患者（术前宫颈锥切术、肿瘤直径<2cm）在根治性子宫切除术后具有极好的生存和低复发风险，他们可能受益于腹腔镜手术的优势。
