Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Gynecol Oncol. 2023 Jul;174:224-230. doi: 10.1016/j.ygyno.2023.05.012. Epub 2023 May 23.
Previously, we suggested that patients with cervical cancer (CC) with tumors ≤2 cm on preoperative magnetic resonance imaging (MRI) are safe candidates for laparoscopic radical hysterectomy (LRH). Here, we aim to investigate whether LRH deteriorates the prognosis of patients with incidentally identified high-risk factors; lymph node metastasis (LNM) or parametrial invasion (PMI).
We identified patients with 2009 FIGO stage IB1 CC who underwent Type C LRH or open radical hysterectomy (ORH) at three tertiary hospitals between 2000 and 2019. Those with a tumor ≤2 cm on preoperative MRI who were not suspicious of LNM or PMI preoperatively were included, while those who were indicated to receive adjuvant treatment but did not actually receive it were excluded. Survival outcomes were compared between the LRH and ORH groups in the overall population, then narrowed down to those with LNM, and then to those with PMI.
In total, 498 patients were included: 299 in the LRH group and 199 in the ORH group. The LRH and ORH groups showed similar 3-year progression-free survival (PFS) (94.0% vs. 93.6%; P = 0.615) and 5-year overall survival (OS) rates (97.2% vs. 96.8%; P = 0.439). On pathologic examination, 49 (9.8%) and 16 (3.2%) patients had LNM and PMI, respectively, and 10 (2.0%) had both. In the LNM subgroup, 5-year PFS rate was not significantly different between the LRH and ORH groups (73.2% vs. 91.7%; P = 0.169). In the PMI subgroup, no difference in PFS was observed between the two groups (P = 0.893).
LRH might not deteriorate recurrence and mortality rates in CC patients with tumors ≤2 cm when adjuvant treatment is appropriately administered, even if pathologic LNM and PMI are incidentally identified.
此前，我们提出对于术前磁共振成像（MRI）显示肿瘤直径≤2cm 的宫颈癌（CC）患者，腹腔镜根治性子宫切除术（LRH）是安全的选择。在此，我们旨在研究 LRH 是否会使术前偶然发现的高危因素（淋巴结转移[LNM]或宫旁浸润[PMI]）患者的预后恶化。
我们在 2000 年至 2019 年期间，在三家三级医院中，识别了接受 C 型 LRH 或开放性根治性子宫切除术（ORH）的 2009 年 FIGO 分期 IB1 CC 患者。纳入了术前 MRI 显示肿瘤直径≤2cm 且术前无 LNM 或 PMI 可疑的患者，而排除了那些需要接受辅助治疗但实际上未接受的患者。比较了 LRH 和 ORH 组在总体人群中的生存结果，然后缩小到 LNM 组，然后缩小到 PMI 组。
共纳入 498 例患者：LRH 组 299 例，ORH 组 199 例。LRH 和 ORH 组的 3 年无进展生存率（PFS）（94.0% vs. 93.6%；P=0.615）和 5 年总生存率（OS）率（97.2% vs. 96.8%；P=0.439）相似。在病理检查中，分别有 49（9.8%）和 16（3.2%）例患者有 LNM 和 PMI，10（2.0%）例患者同时存在 LNM 和 PMI。在 LNM 亚组中，LRH 和 ORH 组的 5 年 PFS 率无显著差异（73.2% vs. 91.7%；P=0.169）。在 PMI 亚组中，两组间 PFS 无差异（P=0.893）。
在适当应用辅助治疗的情况下，LRH 可能不会使肿瘤直径≤2cm 的 CC 患者的复发和死亡率恶化，即使偶然发现病理 LNM 和 PMI。
