Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters
Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters
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DOI：
10.1007/s00404-020-05947-y
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发表时间：
2021-01-22
影响因子：
2.6
通讯作者：
Ignatov, Atanas
中科院分区：
文献类型：
--
作者：
Gennari, Paolo;Gerken, Michael;Ignatov, Atanas
目的比较不同手术方式和治疗中心对早期宫颈癌患者无复发生存率(RFS)和总生存率(OS)的影响。患者和方法进行了一项基于人群的队列研究，研究对象包括2010年1月至2015年12月接受根治性子宫切除术的早期IA1-IIB2宫颈癌患者。结果中位随访时间为5.6年。排除后，413例患者符合分析条件：111例(26.9%)接受了微创手术，302例(73.1%)接受了开放手术。两个治疗组在临床和病理特征方面都达到了良好的平衡。患者的平均年龄为51.0岁。与开放手术相比，心肌梗死与改善的RFS和OS有关。5年无瘤生存率分别为89.2%和73.4%(P=0.004)。5年OS率分别为93.7%和81.8%(P=0.016)。在调整了其他预后协变量后，管理信息系统与RFS的改善进一步相关(HR=0.45，95%CI为0.24~0.86；P=0.015)，但与OS无关。然而，调整治疗中心后，手术入路与RFS无显著差异(HR=0.61，95%CI0.31~1.19；P=0.143)。与在非大学癌症中心接受治疗的患者相比，在大学癌症中心接受治疗的患者的总体存活率显著提高。治疗中心仍然是影响RFS(HR=0.49，95%CI0.28-0.83；p=0.009)和OS(HR=0.50，95%CI0.26-0.94；p=0.031)的重要预后因素。结论早期宫颈癌根治性子宫切除术患者的生存与治疗中心有关，而与手术入路无关。
Purpose The aim of the study was to compare recurrence-free survival (RFS) and overall survival (OS) of patients with early stage cervical cancer in dependence of surgical approach and treatment center. Patients and methods A population-based cohort study including women with early stage IA1-IIB2 cervical cancer treated by radical hysterectomy between January 2010 and December 2015 was performed. Results The median follow-up time was 5.6 years. After exclusions, 413 patients were eligible for analysis: 111 (26.9%) underwent minimal-invasive surgery (MIS) and 302 (73.1%) open surgery. Both treatment groups were well balanced regarding the clinical and pathological characteristics. The mean age of the patients was 51.0 years. MIS was associated with improved RFS and OS compared with the open surgery. The 5-year RFS rates were 89.2% in the MIS group and 73.4% in the open surgery group (p = 0.004). The 5-year OS rates were 93.7% in the MIS group and 81.8% in the open surgery group (p = 0.016). After adjustment for other prognostic covariates, the MIS was further associated with improved RFS (HR = 0.45, 95% CI 0.24-0.86; p = 0.015) but not with OS. Nevertheless, after adjustment for treatment center, the surgical approach was not associated with significant difference in RFS (HR = 0.61, 95% CI 0.31-1.19; p = 0.143). Overall survival of patients treated in university cancer centers was significantly increased compared to patients treated in non-university cancer centers. The treatment center remains a strong prognostic factor regarding RFS (HR = 0.49, 95% CI 0.28-0.83; p = 0.009) and OS (HR = 0.50, 95% CI 0.26-0.94; p = 0.031). Conclusions The treatment center but not the surgical approach was associated with the survival of patients treated with radical hysterectomy for early stage cervical cancer.