COVID-19 Pandemic Impact on Surgical Treatment Methods for Early-Stage Cervical Cancer: A Population-Based Study in Romania.
COVID-19 Pandemic Impact on Surgical Treatment Methods for Early-Stage Cervical Cancer: A Population-Based Study in Romania.
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DOI：
10.3390/healthcare10040639
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发表时间：
2022-03-28
期刊：
影响因子：
2.8
通讯作者：
Gluhovschi, Adrian
中科院分区：
文献类型：
--
作者：
Popescu, Alin;Craina, Marius;Pantea, Stelian;Pirvu, Catalin;Radu, Daniela;Marincu, Iosif;Bratosin, Felix;Bogdan, Iulia;Hosin, Samer;Citu, Cosmin;Bernad, Elena;Neamtu, Radu;Dumitru, Catalin;Mocanu, Adelina Geanina;Gluhovschi, Adrian
宫颈癌是年轻女性最常见的恶性肿瘤之一，在世界各地经常被成功筛查。早期发现使许多重要的治疗选择成为可能，使90%以上的患者能够存活三年以上而不会复发癌症。不幸的是，新冠肺炎大流行给医疗系统和获得癌症护理的机会带来了巨大的压力，决定我们开展一项研究，研究大流行对宫颈癌手术护理的影响，并评估其管理和结果的变化。一项回溯性研究设计使我们能够使用提米斯县紧急临床医院的数据库，将宫颈癌在大流行前的最后48个月与新冠肺炎大流行期间的前24个月的趋势进行比较。新的宫颈癌病例出现在更晚期的临床中(大流行期间34.6%的FIGO III期病例，而大流行前为22.4%，p值=0.047)。这些患者面临着更多的治疗计划变化，手术被推迟，放化疗被推迟。从全部宫颈癌患者队列中，160名早期患者有资格接受治疗干预，他们完成了为期三年的随访期。无病生存期和总生存期不受手术方式的影响，也不受SARS-CoV-2感染的影响(对数等级p值分别为0.449和0.608)。确定的三年死亡风险的个人风险因素与新冠肺炎大流行期间SARS-CoV-2感染和治疗变化无关。我们观察到，在新冠肺炎大流行的前24个月，每年诊断的宫颈癌病例大幅减少，原因是医疗体系法规的变化未能提供与大流行前相同的条件。尽管我们没有观察到早期宫颈癌无病生存率的显著变化，但我们预计，后期确诊病例的过剩将导致生存率下降，迫使医疗保健系统在大流行仍在进行的情况下为这些患者考虑不同的策略。
Being one of the most common malignancies in young women, cervical cancer is frequently successfully screened around the world. Early detection enables for an important number of curative options that allow for more than 90% of patients to survive more than three years without cancer relapse. Unfortunately, the COVID-19 pandemic put tremendous pressure on healthcare systems and access to cancer care, determining us to develop a study on the influence the pandemic had on surgical care of cervical cancer, and to assess changes in its management and outcomes. A retrospective study design allowed us to compare cervical cancer trends of the last 48 months of the pre-pandemic period with the first 24 months during the COVID-19 pandemic, using the database from the Timis County Emergency Clinical Hospital. New cases of cervical cancer presented to our clinic in more advanced stages (34.6% cases of FIGO stage III during the pandemic vs. 22.4% before the pandemic, p-value = 0.047). These patients faced significantly more changes in treatment plans, postponed surgeries, and postponed radio-chemotherapy treatment. From the full cohort of cervical cancer patients, 160 were early stages eligible for curative intervention who completed a three-year follow-up period. The disease-free survival and overall survival were not influenced by the surgical treatment of choice, or by the SARS-CoV-2 infection (log-rank p-value = 0.449, respectively log-rank p-value = 0.608). The individual risk factors identified for the three-year mortality risk were independent of the SARS-CoV-2 infection and treatment changes during the COVID-19 pandemic. We observed significantly fewer cases of cervical cancer diagnosed per year during the first 24 months of the COVID-19 pandemic, blaming the changes in healthcare system regulations that failed to offer the same conditions as before the pandemic. Even though we did not observe significant changes in disease-free survival of early-stage cervical cancers, we expect the excess of cases diagnosed in later stages to have lower survival rates, imposing the healthcare systems to consider different strategies for these patients while the pandemic is still ongoing.
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