Wang Lu, Liu Ping, Duan Hui, Li Pengfei, Li Weili, Chen Chunlin
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Surg. 2023 Apr 27;10:1174490. doi: 10.3389/fsurg.2023.1174490. eCollection 2023.
To discuss the possibility of individualizing the para-tumor resection range (PRR) in cervical cancer patients based on three-dimensional (3D) reconstruction.
We retrospectively included 374 cervical cancer patients who underwent abdominal radical hysterectomy. Preoperative computerized tomography (CT) or magnetic resonance imaging (MRI) data sets were collected to get 3D models. Postoperative specimens were measured to evaluate surgical scope. Oncological outcomes of patients with different depths of stromal invasion and PRR were compared.
A PRR of 32.35 mm was found to be the cut-off point. For the 171 patients with stromal invasion <1/2 depth, patients with a PRR over 32.35 mm had a lower risk of death and higher 5-year overall survival (OS) than that in the ≤32.35 mm group (HR = 0.110, 95% CI: 0.012-0.988, = 0.046; OS: 98.8% vs. 86.8%, = 0.012). No significant differences were found in 5-year disease-free survival (DFS) between the two groups (92.2% vs. 84.4%, = 0.115). For the 178 cases with stromal invasion ≥1/2 depth, no significant differences were found in 5-year OS and DFS between groups (≤32.35 mm group vs. >32.35 mm group, OS: 71.0% vs. 83.0%, = 0.504; DFS: 65.7% vs. 80.4%, = 0.305).
In patients with stromal invasion <1/2 depth, the PRR should reach 32.35 mm to get more survival benefit and in patients with stromal invasion ≥1/2 depth, the PRR should reach 32.35 mm at least to avoid worse prognosis. Cervical cancer patients with different depths of stromal invasion may receive tailoring resection of the cardinal ligament.
探讨基于三维（3D）重建对宫颈癌患者个体化确定肿瘤旁切除范围（PRR）的可能性。
我们回顾性纳入了374例行腹式根治性子宫切除术的宫颈癌患者。收集术前计算机断层扫描（CT）或磁共振成像（MRI）数据集以获取3D模型。测量术后标本以评估手术范围。比较不同基质浸润深度和PRR患者的肿瘤学结局。
发现PRR为32.35 mm是截断点。对于171例基质浸润<1/2深度的患者，PRR超过32.35 mm的患者死亡风险较低，5年总生存率（OS）高于PRR≤32.35 mm组（HR = 0.110，95% CI：0.012 - 0.988，P = 0.046；OS：98.8% 对86.8%，P = 0.012）。两组间5年无病生存率（DFS）无显著差异（92.2% 对84.4%，P = 0.115）。对于178例基质浸润≥1/2深度的病例，两组间5年OS和DFS无显著差异（PRR≤32.35 mm组对>32.35 mm组，OS：71.0% 对83.0%，P = 0.504；DFS：65.7% 对80.4%，P = 0.305）。
对于基质浸润<1/2深度的患者，PRR应达到32.35 mm以获得更多生存益处；对于基质浸润≥1/2深度的患者，PRR至少应达到32.35 mm以避免预后更差。不同基质浸润深度的宫颈癌患者可接受主韧带的个体化切除。
