与开放性子宫切除术相比，高危子宫内膜癌的微创治疗。
Minimally Invasive Compared With Open Hysterectomy in High-Risk Endometrial Cancer.
机构信息
Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain; the Gynecology Oncology Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; the Department of Anesthesiology and Perioperative Medicine and the Department of Gynecologic Oncology and Reproductive Medicine, the University of Texas MD Anderson Cancer Center, Houston, Texas; the Department of Gynecology and Obstetrics, Mayo Clinic, Rochester, Minnesota; the Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain; and the Department of Medicine, University Jaume I (UJI), Castellón, Spain.
出版信息
Obstet Gynecol. 2021 Dec 1;138(6):828-837. doi: 10.1097/AOG.0000000000004606.
OBJECTIVE
To compare disease-free survival between minimally invasive surgery and open surgery in patients with high-risk endometrial cancer.
METHODS
We conducted a multicentric, propensity-matched study of patients with high-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and staging between January 1999 and June 2016 at two centers. High-risk endometrial cancer included grade 3 endometrioid, serous, clear cell, undifferentiated carcinoma or carcinosarcoma with any myometrial invasion. Patients were categorized a priori into two groups based on surgical approach, propensity scores were calculated based on potential confounders and groups were matched 1:1 using nearest neighbor technique. Cox hazard regression analysis and Kaplan-Meier curves evaluated the association of surgical technique with survival.
RESULTS
Of 626 eligible patients, 263 (42%) underwent minimally invasive surgery and 363 (58%) underwent open surgery. In the matched cohort, there were no differences in disease-free survival rates at 5 years between open (53.4% [95% CI 45.6-60.5%]) and minimally invasive surgery (54.6% [95% CI 46.6-61.8]; P=.82). Minimally invasive surgery was not associated with worse disease-free survival (hazard ratio [HR] 0.85, 95% CI 0.63-1.16; P=.30), overall survival (HR 1.04, 95% CI 0.73-1.48, P=.81), or recurrence rate (HR 0.99; 95% CI 0.69-1.44; P=.99) compared with open surgery. Use of uterine manipulator was not associated with worse disease-free survival (HR 1.01, 95% CI 0.65-1.58, P=.96), overall survival (HR 1.18, 95% CI 0.71-1.96, P=.53), or recurrence rate (HR 1.12, 95% CI 0.67-1.87; P=.66).
CONCLUSION
There was no difference in oncologic outcomes comparing minimally invasive and open surgery among patients with high-risk endometrial cancer.
目的
比较高危子宫内膜癌患者微创手术与开腹手术的无病生存率。
方法
本研究为 2 个中心进行的多中心、倾向评分匹配研究，纳入 1999 年 1 月至 2016 年 6 月期间接受子宫切除术、双侧输卵管卵巢切除术和分期手术的高危子宫内膜癌患者。高危子宫内膜癌包括 3 级子宫内膜样癌、浆液性癌、透明细胞癌、未分化癌或任何肌层浸润的癌肉瘤。患者根据手术方式预先分为两组，根据潜在混杂因素计算倾向评分，并采用最近邻技术进行 1:1 匹配。Cox 风险回归分析和 Kaplan-Meier 曲线评估手术技术与生存的关系。
结果
在 626 例符合条件的患者中，263 例（42%）接受了微创手术，363 例（58%）接受了开腹手术。在匹配队列中，开放手术和微创手术 5 年无病生存率无差异，分别为 53.4%（95%CI 45.6%-60.5%）和 54.6%（95%CI 46.6%-61.8%）（P=0.82）。微创手术与无病生存（风险比[HR]0.85，95%CI 0.63-1.16；P=0.30）、总生存（HR 1.04，95%CI 0.73-1.48，P=0.81）或复发率（HR 0.99；95%CI 0.69-1.44，P=0.99）无关。与开腹手术相比，使用子宫操纵器与无病生存（HR 1.01，95%CI 0.65-1.58，P=0.96）、总生存（HR 1.18，95%CI 0.71-1.96，P=0.53）或复发率（HR 1.12，95%CI 0.67-1.87，P=0.66）无关。
结论
在高危子宫内膜癌患者中，微创手术与开腹手术的肿瘤学结局无差异。
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