Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Gynecol Oncol. 2022 Oct;167(1):28-36. doi: 10.1016/j.ygyno.2022.08.003. Epub 2022 Aug 13.
To compare survival outcomes of minimally invasive surgery (MIS) and open surgery for radical hysterectomy (RH) in early cervical cancer patients with histologic subtypes of usual-type adenocarcinoma and adenosquamous carcinoma.
From two centers' cervical cancer cohorts, patients with 2009 FIGO stage IB1-IB2 who underwent RH between 2007 and 2020 were retrospectively identified. Patients with usual-type adenocarcinoma and adenosquamous carcinoma were included in the analysis after pathologic review according to the updated World Health Organization Classification of Tumors. Clinicopathologic characteristics and survival outcomes were compared in terms of open surgery or MIS.
This study included 161 patients. No significant differences were noted in overall survival (OS; P = 0.241) and disease-free survival (DFS; P = 0.156) between patients with usual-type adenocarcinoma (n = 136) and those with adenosquamous carcinoma (n = 25). MIS RH group (n = 99) had a significantly smaller tumor size (P < 0.001), lesser pathologic parametrial invasion (P = 0.001), and lesser lymph node metastasis (P < 0.001) than open RH group (n = 62). MIS and open RH groups showed similar OS (P = 0.201) and 3-year DFS rate (87.9% vs. 75.1%; P = 0.184). In multivariate analysis, worse DFS was not associated with MIS (P = 0.589) but was associated with pathologic parametrial invasion (adjusted HR, 3.41; 95% CI, 1.25-9.29; P = 0.016). Consistent results were observed among patients with usual-type adenocarcinoma; MIS was not associated with worse DFS.
Comparable survival outcomes were found for MIS and open RH in early-stage cervical usual-type adenocarcinoma and adenosquamous carcinoma. Although MIS RH was not a poor prognostic factor, pathologic parametrial invasion was significantly associated with worse DFS in cervical usual-type adenocarcinoma and adenosquamous carcinoma.
比较微创根治性子宫切除术（RH）与开腹 RH 治疗早期宫颈癌组织学类型为普通型腺癌和腺鳞癌患者的生存结局。
从两个中心的宫颈癌队列中，回顾性地选择了 2007 年至 2020 年期间接受 2009 年FIGO 分期 IB1-IB2 期 RH 的患者。根据世界卫生组织肿瘤分类的最新更新，对普通型腺癌和腺鳞癌患者进行病理检查后，将其纳入分析。比较开腹手术或微创 RH 患者的临床病理特征和生存结局。
本研究纳入了 161 例患者。普通型腺癌（n=136）和腺鳞癌（n=25）患者的总生存（OS；P=0.241）和无病生存（DFS；P=0.156）无显著差异。微创 RH 组（n=99）的肿瘤直径显著更小（P<0.001），病理参数侵犯更小（P=0.001），淋巴结转移更小（P<0.001），而开腹 RH 组（n=62）的肿瘤直径更大，病理参数侵犯更大，淋巴结转移更多。微创 RH 组和开腹 RH 组的 OS（P=0.201）和 3 年 DFS 率（87.9% vs. 75.1%；P=0.184）相似。多因素分析显示，DFS 不良与微创 RH 无关（P=0.589），但与病理参数侵犯有关（调整后的 HR，3.41；95%CI，1.25-9.29；P=0.016）。在普通型腺癌患者中也观察到了一致的结果，微创 RH 与 DFS 不良无关。
早期宫颈癌普通型腺癌和腺鳞癌患者微创 RH 与开腹 RH 的生存结局相当。虽然微创 RH 不是预后不良的因素，但病理参数侵犯与普通型腺癌和腺鳞癌患者的 DFS 不良显著相关。
