Nasioudis Dimitrios, Labban Nayla, Gysler Stefan, Ko Emily M, Giuntoli Robert L, Kim Sarah H, Latif Nawar A
Division of Gynecologic Oncology, Penn Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Cancers (Basel). 2024 May 29;16(11):2051. doi: 10.3390/cancers16112051.
To investigate the impact of a prior cervical excisional procedure on the oncologic outcomes of patients with apparent early-stage cervical carcinoma undergoing radical hysterectomy.
The National Cancer Database (2004-2015) was accessed, and patients with FIGO 2009 stage IB1 cervical cancer who had a radical hysterectomy with at least 10 lymph nodes (LNs) removed and a known surgical approach were identified. Patients who did and did not undergo a prior cervical excisional procedure (within 3 months of hysterectomy) were selected for further analysis. Overall survival (OS) was evaluated following the generation of Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to control a priori-selected confounders.
A total of 3159 patients were identified; 37.1% (n = 1171) had a prior excisional procedure. These patients had lower rates of lymphovascular invasion (29.2% vs. 34.9%, = 0.014), positive LNs (6.7% vs. 12.7%, < 0.001), and a tumor size >2 cm (25.7% vs. 56%, < 0.001). Following stratification by tumor size, the performance of an excisional procedure prior to radical hysterectomy was associated with better OS even after controlling for confounders (aHR: 0.45, 95% CI: 0.30, 0.66). The rate of minimally invasive surgery was higher among patients who had a prior excisional procedure (61.5% vs. 53.2%, < 0.001). For these patients, performance of minimally invasive radical hysterectomy was not associated with worse OS (aHR: 1.37, 95% CI: 0.66, 2.82).
For patients undergoing radical hysterectomy, preoperative cervical excision may be associated with a survival benefit. For patients who had a prior excisional procedure, minimally invasive radical hysterectomy was not associated with worse overall survival.
探讨既往宫颈切除手术对接受根治性子宫切除术的早期宫颈癌患者肿瘤学结局的影响。
检索国家癌症数据库（2004 - 2015年），确定国际妇产科联盟（FIGO）2009年IB1期宫颈癌患者，这些患者接受了根治性子宫切除术，切除至少10枚淋巴结且手术入路已知。选择在子宫切除术前3个月内接受和未接受过宫颈切除手术的患者进行进一步分析。绘制Kaplan-Meier曲线评估总生存期（OS），并采用对数秩检验进行比较。构建Cox模型以控制预先选定的混杂因素。
共纳入3159例患者；37.1%（n = 1171）曾接受过宫颈切除手术。这些患者的淋巴管侵犯率较低（29.2%对34.9%，P = 0.014）、淋巴结阳性率较低（6.7%对12.7%，P < 0.001）且肿瘤大小>2 cm的比例较低（25.7%对56%，P < 0.001）。按肿瘤大小分层后，即使在控制混杂因素后，根治性子宫切除术前进行宫颈切除手术与更好的总生存期相关（风险比：0.45，95%可信区间：0.30，0.66）。既往接受过宫颈切除手术的患者中，微创手术率较高（61.5%对53.2%，P < 0.001）。对于这些患者，进行微创根治性子宫切除术与较差的总生存期无关（风险比：1.37，95%可信区间：0.66，2.82）。
对于接受根治性子宫切除术的患者，术前宫颈切除可能与生存获益相关。对于既往接受过宫颈切除手术的患者，微创根治性子宫切除术与较差的总生存期无关。
