Moffitt Cancer Center, Department of Clinical Science, United States of America.
Moffitt Cancer Center, Department of Cancer Epidemiology, United States of America.
Gynecol Oncol. 2022 Jun;165(3):514-521. doi: 10.1016/j.ygyno.2022.04.004. Epub 2022 Apr 26.
To determine the effect of distance to closest negative margin on survival after pelvic exenteration (PE).
In this retrospective analysis of PE at Moffitt Cancer Center from 2000 to 2019, baseline characteristics, clinical details, and outcomes were ascertained. Distance to closest negative margin was measured. Close and distant negative margins were defined as <3 mm and ≥3 mm from malignancy to nearest surgical margin, respectively. Overall survival (OS) and progression-free survival (PFS) were determined, and Kaplan-Meier curves were compared. Cox proportional hazards regression was used to examine the association of margin status with OS and PFS.
Of 124 PEs with malignancy, 80 (64.5%) had negative margins. Median survival was 62 (95% confidence interval [CI] 27-70) months for negative and 21 (95% CI 15-29) months for positive margins. Of 76 with negative margins and documented margin length, 26 had close and 50 had distant margins. Median survival was 32 (95% CI 14-62) months for close and 111 (95% CI 42-166) months for distant margins. Distant margins were associated with improved OS (p = 0.0054) and PFS (p = 0.0099) compared to close margins. After adjusting for other prognostic factors, patients with distant margins had significantly decreased risk of all-cause mortality (HR 0.39, 95% CI 0.19-0.78; p = 0.008) and progression (HR 0.48, 95% CI 0.23-0.99; p = 0.04) compared to positive margins. No significant differences in OS or PFS were observed between close and positive margins. This survival benefit remained among those with cervical cancer. Median survival in this cohort was 34.1 (95% CI 2.0-69.8) months for close and 165.7 (95% CI 24.5-165.7) for distant margins.
Distant margins following PE are associated with improved OS and PFS compared to close margins.
确定盆腔廓清术后（PE）最近切缘距离对生存的影响。
本研究回顾性分析了 2000 年至 2019 年在莫菲特癌症中心进行的 PE，确定了基线特征、临床细节和结果。测量最近切缘距离。将接近和远离切缘分别定义为恶性肿瘤到最近手术切缘的距离<3mm 和≥3mm。确定总生存（OS）和无进展生存（PFS），并比较 Kaplan-Meier 曲线。Cox 比例风险回归用于检验切缘状态与 OS 和 PFS 的关系。
在 124 例恶性肿瘤的 PE 中，80 例（64.5%）有阴性切缘。阴性切缘的中位生存时间为 62 个月（95%可信区间 [CI] 27-70），阳性切缘为 21 个月（95% CI 15-29）。在 76 例有阴性切缘且有记录的切缘长度的患者中，26 例为近距离切缘，50 例为远距离切缘。近距离切缘的中位生存时间为 32 个月（95% CI 14-62），远距离切缘的中位生存时间为 111 个月（95% CI 42-166）。与近距离切缘相比，远距离切缘与 OS（p=0.0054）和 PFS（p=0.0099）的改善相关。在调整其他预后因素后，与阳性切缘相比，远处切缘的患者全因死亡率（HR 0.39，95% CI 0.19-0.78；p=0.008）和进展风险（HR 0.48，95% CI 0.23-0.99；p=0.04）显著降低。近距离和阳性切缘之间的 OS 或 PFS 无显著差异。在宫颈癌患者中，这种生存获益仍然存在。在这组患者中，近距离切缘的中位生存时间为 34.1 个月（95% CI 2.0-69.8），而远距离切缘的中位生存时间为 165.7 个月（95% CI 24.5-165.7）。
与近距离切缘相比，PE 后远处切缘与 OS 和 PFS 的改善相关。
