Guerra Rosa A, Tucker Lue-Yen, Littell Ramey, Kay Allison H
Kaiser Permanente San Francisco, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, San Francisco, CA, USA.
Kaiser Permanente, Division of Research, Pleasanton, CA, USA.
Int J Gynecol Cancer. 2025 Jul;35(7):101928. doi: 10.1016/j.ijgc.2025.101928. Epub 2025 May 10.
This study aimed to compare survival outcomes between minimally invasive surgery (MIS) and open surgery for early-stage cervical cancer in a managed care community patient population.
This retrospective study included adult patients who underwent a hysterectomy or trachelectomy for a pre-operative clinical-pathologic diagnosis of stage IA1 to IIA1 cervical cancer as defined by the International Federation of Gynecology and Obstetrics 2018 cervical cancer staging. Patients were diagnosed with cervical cancer between January 2005 and December 2018 at a Kaiser Permanente Northern California hospital. We compared outcomes between patients with stage IA2 to IIA1 cervical cancer who underwent a radical MIS and those who underwent open surgery. We separately analyzed patients with stage IA1 disease.
A total of 227 patients (55%) with stage IA2 to IIA1 disease underwent MIS and were compared with 187 patients (45%) in the open cohort. In most cases, MIS involved robotic-assisted surgery (77%). The median length of follow-up was 82.6 months (interquartile range; 53.8-106.4) for MIS and 156.6 months (interquartile range; 139.1-168.7) for the open group. There were 27 recurrences in the MIS group (12%) and 8 recurrences in the open group (4%) (p < .01). The 10-year recurrence-free survival was significantly lower in the MIS group (87%, 95% CI 81.0% to 90.7%) than in the open group (97%, 95% CI 92.4% to 98.4%, p < .01). Among patients with tumor size <2 cm, the 10-year recurrence-free survival was significantly lower with MIS (89%, 95% CI 82.7% to 93.5%) than with open surgery (98%, 95% CI 92.3% to 99.5%, p < .01). The 10-year disease-specific survival was also inferior for MIS (96%, 95% CI 92.0% to 98.2%) than for open surgery (100%, 95% CI 100% to 100%, p < .01). None of the 133 patients with stage IA1 disease experienced a cancer recurrence, regardless of surgical approach. Prior cone biopsy was associated with a lower risk of recurrence (adjusted HR 0.48, 95% CI 0.22 to 1.03).
Patients with stage IA2 to IIA1 cervical cancer, including those with tumors <2 cm, had inferior survival outcomes following MIS compared with open surgery. Patients with stage IA1 cervical cancer have a very low risk of recurrence regardless of surgical approach.
本研究旨在比较在管理式医疗社区患者群体中，微创手术（MIS）与开放手术治疗早期宫颈癌的生存结局。
这项回顾性研究纳入了成年患者，这些患者因术前临床病理诊断为国际妇产科联盟2018年宫颈癌分期定义的IA1至IIA1期宫颈癌而接受了子宫切除术或宫颈切除术。患者于2005年1月至2018年12月间在北加利福尼亚州凯撒医疗集团的一家医院被诊断为宫颈癌。我们比较了接受根治性MIS的IA2至IIA1期宫颈癌患者与接受开放手术患者的结局。我们对IA1期疾病的患者进行了单独分析。
共有227例（55%）IA2至IIA1期疾病患者接受了MIS，并与开放手术队列中的187例（45%）患者进行了比较。在大多数情况下，MIS涉及机器人辅助手术（77%）。MIS组的中位随访时间为82.6个月（四分位间距；53.8 - 106.4），开放手术组为156.6个月（四分位间距；139.1 - 168.7）。MIS组有27例复发（12%），开放手术组有8例复发（4%）（p < 0.01）。MIS组的10年无复发生存率（87%，95%CI 81.0%至90.7%）显著低于开放手术组（97%，95%CI 92.4%至98.4%，p < 0.01）。在肿瘤大小<2 cm的患者中，MIS组的10年无复发生存率（89%，95%CI 82.7%至93.5%）显著低于开放手术组（98%，95%CI 92.3%至99.5%，p < 0.01）。MIS组的10年疾病特异性生存率（96%，95%CI 92.0%至98.2%）也低于开放手术组（100%，95%CI 100%至100%，p < 0.01）。133例IA1期疾病患者中，无论采用何种手术方式，均未发生癌症复发。先前的锥形活检与较低的复发风险相关（调整后HR 0.48，95%CI 0.22至1.03）。
IA2至IIA1期宫颈癌患者，包括肿瘤<2 cm的患者，与开放手术相比，MIS后的生存结局较差。IA1期宫颈癌患者无论采用何种手术方式，复发风险都非常低。
