Fertility-sparing trachelectomy for early-stage cervical cancer: A proposal of an ideal candidate.
Fertility-sparing trachelectomy for early-stage cervical cancer: A proposal of an ideal candidate.
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DOI：
10.1016/j.ygyno.2019.11.021
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发表时间：
2020-03
影响因子：
4.7
通讯作者：
Mikami M
中科院分区：
文献类型：
--
作者：
Machida H;Iwata T;Okugawa K;Matsuo K;Saito T;Tanaka K;Morishige K;Kobayashi H;Yoshino K;Tokunaga H;Ikeda T;Shozu M;Yaegashi N;Enomoto T;Mikami M
目的：为保留生育能力的早期宫颈癌患者提供一种理想的手术方式。这项全国性、多中心的回顾性研究由日本妇产科学会进行，研究对象为患有临床I-II期宫颈癌的45岁女性，她们在2009至2013年间计划了保留生育能力的沙眼切除术和盆腔淋巴清扫术(n=393)。理想的候选肿瘤大小为≤2 cm，无淋巴结转移，无深层间质侵犯，无高危组织学改变(n=284，69.6%)。不太理想的候选人被定义为具有这四种特征中的任何一种(n=109，30.4%)。用倾向评分与治疗加权概率倒数来评估生存结果。与理想的患者(ALL，P<；0.05)相比，不太理想的患者更有可能接受子宫切除术(22.9%比3.2%)、术后放疗(11.9%比0.4%)或化疗(32.1%比3.2%)。加权模型显示，在接受沙眼切除术的患者中，与理想的患者相比，不理想的患者的无病生存率(5年生存率：85.5%比95.5%；HR3.93，95%CI1.99~7.74；P<；0.001)和原因特定生存率(92.5%比98.6%；HR5.47，95%CI1.68~17.8，P=0.001)显著降低。同样，在年轻、有小肿瘤或鳞状组织学、只接受手术的患者中，不太理想的患者与理想的患者相比，无病生存率显著降低(ALL，P<；0.05)。与理想的候选人相比，不太理想的候选人的复发风险和癌症死亡率大约高出四倍。我们研究中提出的保留生育能力的早期宫颈癌沙眼切除术的理想候选者可能会作为日本制定保留生育能力的沙眼切除术指南的未来框架。
To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes. Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99–7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68–17.8, P = 0.001) compared with ideal candidates. Similarly, less-ideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05). Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.
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影响因子：
9.8
作者：
Machida H;Mandelbaum RS;Mikami M;Enomoto T;Sonoda Y;Grubbs BH;Paulson RJ;Roman LD;Wright JD;Matsuo K
通讯作者：
Matsuo K
影响因子：
--
作者：
Matsuo K;Shimada M;Yokota H;Satoh T;Katabuchi H;Kodama S;Sasaki H;Matsumura N;Mikami M;Sugiyama T
通讯作者：
Sugiyama T
影响因子：
4.7
作者：
Viswanathan, AN;Deavers, MT;Eifel, PJ
通讯作者：
Eifel, PJ
影响因子：
2.5
作者：
Retherford, RD;Ogawa, N;Matsukura, R
通讯作者：
Matsukura, R
DOI：
10.1097/igc.0b013e318296034e
发表时间：
2013-07
期刊：
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
影响因子：
--
作者：
Wethington SL;Sonoda Y;Park KJ;Alektiar KM;Tew WP;Chi DS;Leitao MM Jr;Jewell EL;Barakat RR;Abu-Rustum NR
通讯作者：
Abu-Rustum NR