Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.
Gynecol Oncol. 2023 Sep;176:122-129. doi: 10.1016/j.ygyno.2023.07.009. Epub 2023 Jul 27.
To identify clinicopathological factors associated with disease recurrence for patients with 2018 FIGO stage IA with lymphovascular invasion to IB1 cervical cancer treated with minimally invasive surgery (MIS).
A total of 722 patients with cervical cancer between January 2010 and February 2021 were identified. Clinicopathological factors related to disease recurrence were analyzed. Disease-free survival (DFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method. To determine prognostic factors for DFS, a Cox proportional hazard regression model was used.
Of 722 patients, 49 (6.8%) experienced disease recurrence (37 pelvis, 1 para-aortic lymph node, and 11 peritoneum). Five-year DFS and OS rates were 90.7% and 98.1%, respectively. In multivariate analysis, risk factors associated with disease recurrence were residual disease in the remaining cervix (OR, 3.122; 95% CI, 1.152-8.461; p = 0.025), intracorporeal colpotomy (OR, 3.252; 95% CI, 1.507-7.017; p = 0.003), and positive resection margin (OR, 3.078; 95% CI, 1.031-9.193; p = 0.044). The non-conization group had a higher percentage of stage IB1 (77.4% vs. 64.6%; p = 0.004) and larger tumor (10 mm vs. 7 mm; p < 0.001) than the conization group. Intracorporeal colpotomy and residual disease in the remaining cervix were independent variables associated with disease recurrence in patients undergoing MIS following conization.
During MIS, patients with cervical cancer ≤2 cm in size can be vulnerable to peritoneal recurrences. Patients diagnosed with invasive cancer through conization often have low-risk pathological features, which may affect their survival outcomes.
确定 2018 年 FIGO 分期 IA 伴淋巴血管侵犯至 IB1 期宫颈癌患者接受微创手术（MIS）治疗后与疾病复发相关的临床病理因素。
共纳入 2010 年 1 月至 2021 年 2 月期间的 722 例宫颈癌患者。分析与疾病复发相关的临床病理因素。采用 Kaplan-Meier 法估计无病生存（DFS）和总生存（OS）率。采用 Cox 比例风险回归模型确定 DFS 的预后因素。
722 例患者中，49 例（6.8%）发生疾病复发（37 例盆腔、1 例主动脉旁淋巴结、11 例腹膜）。5 年 DFS 和 OS 率分别为 90.7%和 98.1%。多因素分析显示，与疾病复发相关的危险因素为宫颈残留病灶（OR，3.122；95%CI，1.152-8.461；p=0.025）、经阴道子宫切除术（OR，3.252；95%CI，1.507-7.017；p=0.003）和阳性切缘（OR，3.078；95%CI，1.031-9.193；p=0.044）。非锥切组 IB1 期患者比例（77.4%比 64.6%；p=0.004）和肿瘤直径较大（10mm 比 7mm；p<0.001）均高于锥切组。经阴道子宫切除术和宫颈残留病灶是锥切术后接受 MIS 治疗患者疾病复发的独立变量。
在 MIS 期间，大小≤2cm 的宫颈癌患者易发生腹膜复发。通过锥切诊断为浸润性癌的患者往往具有低风险的病理特征，这可能影响其生存结局。
