Viveros-Carreño David, Agusti Nuria, Wu Chi-Fang, Melamed Alexander, Nitecki Wilke Roni, Kanbergs Alexa, Pareja René, Zamorano Abigail S, Rauh-Hain J Alejandro
Unidad Ginecología Oncológica, Grupo de Investigación GIGA, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo-CTIC, the Department of Gynecologic Oncology, Clínica Universitaria Colombia, the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, and Gynecologic Oncology, Clínica Astorga, Medellín, Colombia; the Department of Gynecologic Oncology and Reproductive Medicine and the Department of Health Services Research, University of Texas MD Anderson Cancer Center, and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas; and the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
Obstet Gynecol. 2025 Jan 1;145(1):99-107. doi: 10.1097/AOG.0000000000005743. Epub 2024 Sep 26.
To assess the effect on overall survival of simple hysterectomy with lymph node staging compared with radical hysterectomy with lymph node staging for patients with early-stage cervical cancer.
We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with early cervical carcinoma of 2 cm or smaller (stage IA1 with lymphovascular space invasion through IIA1, International Federation of Gynecology and Obstetrics staging) from 2010 to 2019. After 1:1 propensity score matching, we compared patients who underwent simple hysterectomy with lymph node staging and those with radical hysterectomy with lymph node staging. The variables used for matching were age, tumor size, race and ethnicity, lymphovascular space invasion, year of diagnosis, Charlson-Deyo comorbidity score, histology, and surgical approach. The primary outcome was overall survival at the end of follow-up. Secondary outcomes included 30-day readmission rate and 30- and 90-day mortality rates.
In total, 4,167 patients met the inclusion criteria, of whom 2,637 patients (63.3%) underwent radical hysterectomy and lymph node staging and 1,530 patients (36.7%) underwent simple hysterectomy and lymph node staging. After propensity score matching, 1,529 patients in each group were included. There was no statistically significant difference in overall survival between patients who underwent simple hysterectomy and those who underwent radical hysterectomy (hazard ratio 1.25, 95% CI, 0.91-1.73, P =.17). Subgroup analysis by histology, lymphovascular space invasion, tumor size, and surgical approach did not reveal statistically significant differences in overall survival according to hysterectomy type. The hysterectomy groups also did not significantly differ in 30-day readmission rate (4.6% vs 4.2%, P =.73), 30-day mortality rate (0.1% vs 0%, P =.14), or 90-day mortality rate (0.1% vs 0.1%, P =.93).
Patients with low-risk cervical cancer could undergo less radical surgery without a negative effect on their oncologic outcomes.
评估早期宫颈癌患者单纯子宫切除加淋巴结分期与根治性子宫切除加淋巴结分期对总生存期的影响。
我们对国家癌症数据库中2010年至2019年诊断为2厘米及以下早期宫颈癌（国际妇产科联盟分期为IA1伴脉管间隙浸润至IIA1期）的患者进行了一项回顾性队列研究。在1:1倾向评分匹配后，我们比较了接受单纯子宫切除加淋巴结分期的患者和接受根治性子宫切除加淋巴结分期的患者。用于匹配的变量包括年龄、肿瘤大小、种族和民族、脉管间隙浸润、诊断年份、Charlson-Deyo合并症评分、组织学和手术方式。主要结局是随访结束时的总生存期。次要结局包括30天再入院率以及30天和90天死亡率。
共有4167例患者符合纳入标准，其中2637例患者（63.3%）接受了根治性子宫切除加淋巴结分期，1530例患者（36.7%）接受了单纯子宫切除加淋巴结分期。倾向评分匹配后，每组纳入1529例患者。接受单纯子宫切除的患者与接受根治性子宫切除的患者在总生存期方面无统计学显著差异（风险比1.25，95%置信区间，0.91 - 1.73，P = 0.17）。按组织学、脉管间隙浸润、肿瘤大小和手术方式进行的亚组分析未显示根据子宫切除类型在总生存期上有统计学显著差异。子宫切除组在30天再入院率（4.6%对4.2%，P = 0.73）、30天死亡率（0.1%对0%，P = 0.14）或90天死亡率（0.1%对0.1%，P = 0.93）方面也无显著差异。
低风险宫颈癌患者可以接受创伤较小的手术，而不会对其肿瘤学结局产生负面影响。
