Radical hysterectomy and pelvic lymphadenectomy for stage IB2 cervical cancer
Radical hysterectomy and pelvic lymphadenectomy for stage IB2 cervical cancer
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DOI：
10.1016/j.ygyno.2004.01.038
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发表时间：
2004-05-01
影响因子：
4.7
通讯作者：
Secord, AA
中科院分区：
文献类型：
--
作者：
Havrilesky, LJ;Leath, CA;Secord, AA
客观的。我们希望评估主要接受根治性子宫切除术和淋巴结切除术治疗的 1132 期宫颈癌患者的生存率和不良结果。方法。对 1987 年至 2002 年在两家机构接受 1132 期宫颈癌初次根治性子宫切除术的所有患者进行了回顾。患者被分为低风险组、中风险组（妇科肿瘤组协议 92 标准）和高风险组（阳性淋巴结、切缘或宫旁组织）。使用Kaplan-Meier方法和多变量分析来分析生存期和无进展间期。结果。 72 例患者接受了初次 III 型根治性子宫切除术和淋巴结切除术（72 例盆腔切除术，58 例盆腔和主动脉旁切除术）。患者被分为低（n = 6）、中（it = 49）或高（it = 17）复发风险。高危组、中危组和低危组的接受辅助治疗的比例分别为 94%、12% 和 0%。五年生存率为 72%，而五年进展无离子生存率为 63%。按风险组划分的五年总生存率和无进展生存率分别为 47% 和 40%（高风险）、80% 和 66%（中风险）、100% 和 100%（低风险）。多变量分析中生存的预测因素包括白种人种 (P = 0.001)、年龄较大 (P = 0.017)、内 2/3 宫颈壁视野 (P = 0.045) 和无淋巴管侵犯 (P < 0.001)。 10/72 (13.9%) 的患者出现严重并发症。在 34 名接受放射治疗的患者中，两名 (5.9%) 出现了放射引起的并发症。结论。根治性子宫切除术和淋巴结切除术以及随后的定制辅助治疗是 IB2 期宫颈癌主要放疗的合理替代方案。具有低风险和中风险因素的患者经过初次手术治疗后可获得满意的结果。一项前瞻性随机试验将阐明 1132 期疾病患者初始治疗的最佳模式。 (C) 2004 Elsevier Inc. 保留所有权利。
Objective. We wished to evaluate survival and adverse outcomes of patients with stage 1132 cervical cancer treated primarily with radical hysterectomy and lymphadenectomy.Methods. A review was performed of all patients undergoing primary radical hysterectomy for stage 1132 cervical cancer at two institutions from 1987 to 2002. Patients were stratified into low, intermediate (Gynecologic Oncology Group protocol 92 criteria), and high-risk (positive nodes, margins, or parametria) groups. Survival and progression-free interval were analyzed using the Kaplan-Meier method and multivariate analysis.Results. Seventy-two patients underwent primary type III radical hysterectomy and lymphadenectomy (72 pelvic, 58 pelvic and paraaortic). Patients were classified as low (n = 6), intermediate (it = 49), or high (it = 17) risk for recurrence. Adjuvant therapy was administered to 94%, 12%, and 0% of the high-, intermediate-, and low-risk groups, respectively. Five-year survival was 72%, while 5-year progress ion-free survival was 63%. Five-year overall and progression-free survival by risk group were 47% and 40% (high-risk), 80% and 66% (intermediate-risk), 100% and 100% (low-risk). Predictors of survival in multivariate analysis were Caucasian race (P = 0.001), older age (P = 0.017), inner 2/3 cervical wall invision (P = 0.045), and absence of lymph-vascular invasion (P < 0.001). Major complications were experienced by 10/72 (13.9%) patients. Among 34 patients who received radiation therapy, two (5.9%) experienced complications attributable to radiation.Conclusions. Radical hysterectomy and lymphadenectomy followed by tailored adjuvant therapy is a reasonable alternative to primary radiotherapy for stage IB2 cervical cancer. Patients with low- and intermediate-risk factors have satisfactory results after primary surgical management. A prospective randomized trial will clarify the optimal mode of initial therapy for patients with stage 1132 disease. (C) 2004 Elsevier Inc. All rights reserved.