Li Haoran, Wu Jiao, Xu Qing, Chen Yixin, Cheng Xi
Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Gynecol Oncol. 2025 May;36(3):e42. doi: 10.3802/jgo.2025.36.e42. Epub 2024 Oct 22.
To assess survival differences between non-extensive surgery (NES) and extensive surgery (ES) in International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical cancer patients receiving chemotherapy from a population-based database, the Surveillance, Epidemiology and End Results.
Propensity matching was conducted to minimize heterogeneity. Survival analysis was performed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards model.
A total of 154 patients met screening criteria, among whom 84 patients (84/154) underwent NES while 70 patients (70/154) underwent ES. After matching, no survival advantage was observed in ES group compared with NES group (p=0.066; hazard ratio [HR]=1.54; 95% confidence interval [CI]=0.97-2.42). Stratified analyses suggested ES prolonged overall survival in patients with histology other than squamous cell carcinoma and adenocarcinoma (p=0.028; HR=0.36; 95% CI=0.15-0.89) and American Joint Committee on Cancer (AJCC) T stage T1 (p=0.009; HR=0.18; 95% CI=0.05-0.66). Despite no survival benefit after regional lymph node surgery (p=0.629; HR=0.88; 95% CI=0.53-1.47), subgroup analyses demonstrated that patients younger than 50 (p=0.006; HR=0.21; 95% CI=0.07-0.64), with AJCC T stage T1 (p=0.002; HR=0.09; 95% CI=0.02-0.42), T3 (p=0.001; HR=0.02; 95% CI=0.00-0.21), hematogenous metastasis (p=0.036; HR=0.27; 95% CI=0.08-0.92) and without surgery of other sites (p0.040; HR=0.01; 95% CI=0.00-0.79) might achieve longer survival after regional lymph node surgery.
In conclusion, ES or regional lymph node surgery may provide survival advantage for certain subgroup of FIGO IVB cervical cancer patients receiving chemotherapy. However, it deserves large scale prospective clinical trials to confirm.
基于人群数据库监测、流行病学和最终结果，评估国际妇产科联盟（FIGO）IVB期宫颈癌患者接受化疗时，非广泛性手术（NES）与广泛性手术（ES）之间的生存差异。
进行倾向匹配以尽量减少异质性。采用Kaplan-Meier法、对数秩检验和Cox比例风险模型进行生存分析。
共有154例患者符合筛查标准，其中84例（84/154）接受了NES，70例（70/154）接受了ES。匹配后，与NES组相比，ES组未观察到生存优势（p = 0.066；风险比[HR]=1.54；95%置信区间[CI]=0.97 - 2.42）。分层分析表明，ES可延长非鳞状细胞癌和腺癌组织学类型患者的总生存期（p = 0.028；HR = 0.36；95% CI = 0.15 - 0.89）以及美国癌症联合委员会（AJCC）T分期为T1的患者的总生存期（p = 0.009；HR = 0.18；95% CI = 0.05 - 0.66）。尽管区域淋巴结手术后无生存获益（p = 0.629；HR = 0.88；95% CI = 0.53 - 1.47），但亚组分析显示，年龄小于50岁（p = 0.006；HR = 0.21；95% CI = 0.07 - 0.64）、AJCC T分期为T1（p = 0.002；HR = 0.09；95% CI = 0.02 - 0.42）、T3（p = 0.001；HR = 0.02；95% CI = 0.00 - 0.21）、有血行转移（p = 0.036；HR = 0.27；95% CI = 0.08 - 0.92）且未进行其他部位手术的患者（p = 0.040；HR = 0.01；95% CI = 0.00 - 0.79）在区域淋巴结手术后可能获得更长的生存期。
总之，ES或区域淋巴结手术可能为接受化疗的特定亚组FIGO IVB期宫颈癌患者提供生存优势。然而，这值得大规模前瞻性临床试验来证实。
