Divisions of Gynecologic Oncology University of Toronto, Canada.
Department of Biostatistics, McMaster University, Canada.
Gynecol Oncol. 2022 Aug;166(2):230-235. doi: 10.1016/j.ygyno.2022.05.011. Epub 2022 May 27.
Although minimally invasive hysterectomy (MIS-H) has been associated with worse survival compared to abdominal hysterectomy (AH) for cervical cancer, only 8% of patients in the LACC trial had microinvasive disease (Stage IA1/IA2). We sought to determine differences in outcome among patients undergoing MIS-H, AH or combined vaginal-laparoscopic hysterectomy (CVLH) for microinvasive cervical cancer.
A retrospective cohort study of all patients undergoing hysterectomy (radical and non radical) for FIGO 2018, microinvasive cervical cancer across 10 Canadian centers between 2007 and 2019 was performed. Recurrence free survival (RFS) was estimated using Kaplan Meier Survival analysis. Chi-square and log-rank tests were used to compare outcomes.
423 patients with microinvasive cervical cancer were included; 259 (61.2%) Stage IA1 (22/8.5% with LVSI) and 164(38.8%) IA2. The median age was 44 years (range 24-81). The most frequent histology was squamous (59.4%). Surgical approach was: 50.1% MIS-H (robotic or laparoscopic), 35.0% AH and 14.9% CVLH. Overall, 70.9% underwent radical hysterectomy and 76.5% had pelvic lymph node assessment. There were 16 recurrences (MIS-H:4, AH:9, CVLH: 3). No significant difference in 5-year RFS was found (96.7% MIS-H, 93.7% AH, 90.0% CVLH, p = 0.34). In a sub-analysis of patients with IA1 LVSI+/IA2(n = 186), survival results were similar. Further, there was no significant difference in peri-operative complications (p = 0.19). Patients undergoing MIS-H had a shorter median length of stay(0 days vs 3 (AH) vs. 1.5 (CVLH), p < 0.001), but had more ER visits (16.0% vs 3.6% (AH), 3.5% (CVLH), p = 0.036).
In this cohort, including only patients with microinvasive cervical cancer, no difference in recurrence was found by surgical approach. This may be due to the low rate of recurrence making differences hard to detect or due to a true lack of difference. Hence, this patient population may benefit from MIS without compromising oncologic outcomes.
尽管微创子宫切除术（MIS-H）与宫颈癌的腹式子宫切除术（AH）相比生存率较差，但 LACC 试验中只有 8%的患者患有微浸润性疾病（IA1/IA2 期）。我们旨在确定微浸润性宫颈癌患者接受 MIS-H、AH 或联合阴道腹腔镜子宫切除术（CVLH）治疗的结局差异。
对 2007 年至 2019 年间加拿大 10 个中心的所有接受 FIGO 2018 微浸润性宫颈癌根治性和非根治性子宫切除术的患者进行了回顾性队列研究。使用 Kaplan-Meier 生存分析估计无复发生存率（RFS）。使用卡方检验和对数秩检验比较结果。
共纳入 423 例微浸润性宫颈癌患者；259 例（61.2%）IA1 期（22 例，22/8.5%有 LVSI）和 164 例（38.8%）IA2 期。中位年龄为 44 岁（范围 24-81 岁）。最常见的组织学类型为鳞状（59.4%）。手术方式为：50.1%为 MIS-H（机器人或腹腔镜），35.0%为 AH，14.9%为 CVLH。总体而言，70.9%行根治性子宫切除术，76.5%行盆腔淋巴结评估。共有 16 例复发（MIS-H：4 例，AH：9 例，CVLH：3 例）。5 年 RFS 无显著差异（MIS-H：96.7%，AH：93.7%，CVLH：90.0%，p=0.34）。在 IA1 LVSI+/IA2 患者的亚分析中（n=186），生存结果相似。此外，围手术期并发症无显著差异（p=0.19）。行 MIS-H 患者的中位住院时间较短（0 天 vs 3 天（AH） vs. 1.5 天（CVLH），p<0.001），但 ER 就诊次数较多（16.0% vs 3.6%（AH），3.5%（CVLH），p=0.036）。
在本队列中，仅包括微浸润性宫颈癌患者，手术方式无复发差异。这可能是由于复发率低，难以发现差异，或者是因为确实没有差异。因此，该患者人群可能受益于微创治疗而不会影响肿瘤学结局。
