诊断性腹腔镜检查在局部晚期宫颈癌分期中的作用。

The role of diagnostic laparoscopy in locally advanced cervical cancer staging.

机构信息

UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.

出版信息

Eur J Surg Oncol. 2024 Dec;50(12):108645. doi: 10.1016/j.ejso.2024.108645. Epub 2024 Aug 26.

DOI:10.1016/j.ejso.2024.108645

PMID:39214031

Abstract

OBJECTIVE

Peritoneal involvement may be overlooked in patients with locally advanced cervical cancer (LACC). This may lead to underestimation of prognosis and to undertreatment limited to locoregional disease locations. However, staging laparoscopy in LACC is not routinely performed. The primary aim of this study was to determine the proportion of peritoneal metastasis by laparoscopy and the factors associated with peritoneal metastasis in patients with LACC. Secondary aims were to evaluate the performance of staging imaging in detecting peritoneal disease and the prognosis of patients with peritoneal metastasis.

METHODS

Retrospective single-institution study including consecutive patients with newly diagnosed LACC (FIGO 2018 stage IB3 and IIA2-IVA) between 06/2015 and 06/2020. All women underwent PET/CT scan, MRI scan and diagnostic laparoscopy at the time of examination under anesthesia (EUA), as part of cervical cancer staging. Peritoneal metastasis was histologically confirmed in all cases.

RESULTS

251 patients were included. 33 (13.2 %) had peritoneal metastasis. The treatment plan was changed for 28/33 (84.8 %) patients with peritoneal metastasis (11.1 % of the entire LACC cohort). Multivariate analysis demonstrated that grade 3 (OR:1.572, 95%CI:1.021-2.419; p = 0.040) and AJCC stage T3-4 (OR:3.435, 95%CI:1.482-7.960; p = 0.004) were variables associated with increased risk of peritoneal metastasis. Sensitivity of PET/CT-scan and MRI-scan in detecting peritoneal metastasis was 4.5 % (95%CI:0.1-22.8) and 13.8 % (95%CI:3.9-31.7), respectively. Peritoneal metastasis was independently associated with worse PFS and OS (HR:3.008, 95%CI:1.779-5.087, p < 0.001 and HR:4.078, 95%CI:2.232-7.451; p < 0.001, respectively).

CONCLUSION

LACC patients with grade 3 histology and/or AJCC stage T3-4 had high-risk of peritoneal metastasis and diagnostic laparoscopy might be considered as part of cervical cancer staging in these patients. Peritoneal metastasis was an independent factor associated with worse PFS and OS.

摘要

目的

局部晚期宫颈癌（LACC）患者可能会忽视腹膜受累。这可能导致对预后的低估和对仅限于局部疾病部位的治疗不足。然而，LACC 中并未常规进行腹腔镜分期。本研究的主要目的是确定腹腔镜下腹膜转移的比例以及与 LACC 患者腹膜转移相关的因素。次要目的是评估分期成像在检测腹膜疾病中的表现以及腹膜转移患者的预后。

方法

这是一项回顾性单中心研究，纳入了 2015 年 6 月至 2020 年 6 月期间新诊断为 LACC（FIGO 2018 分期 IB3 和 IIA2-IVA）的连续患者。所有女性在全身麻醉下检查时（EUA）均接受 PET/CT 扫描、MRI 扫描和诊断性腹腔镜检查，作为宫颈癌分期的一部分。所有病例均经组织学证实存在腹膜转移。

结果

共纳入 251 例患者。33 例（13.2%）有腹膜转移。28/33（84.8%）例腹膜转移患者的治疗方案发生改变（占整个 LACC 队列的 11.1%）。多变量分析表明，G3（OR：1.572，95%CI：1.021-2.419；p=0.040）和 AJCC 分期 T3-4（OR：3.435，95%CI：1.482-7.960；p=0.004）是与腹膜转移风险增加相关的变量。PET/CT 扫描和 MRI 扫描检测腹膜转移的灵敏度分别为 4.5%（95%CI：0.1-22.8）和 13.8%（95%CI：3.9-31.7）。腹膜转移与较差的 PFS 和 OS 独立相关（HR：3.008，95%CI：1.779-5.087，p<0.001 和 HR：4.078，95%CI：2.232-7.451；p<0.001）。