Ovarian Conservation and Overall Survival in Young Women With Early-Stage Cervical Cancer.
Ovarian Conservation and Overall Survival in Young Women With Early-Stage Cervical Cancer.
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DOI：
10.1097/aog.0000000000001754
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发表时间：
2017-01
影响因子：
7.2
通讯作者：
Wright JD
中科院分区：
文献类型：
--
作者：
Matsuo K;Machida H;Shoupe D;Melamed A;Muderspach LI;Roman LD;Wright JD
确定子宫切除术中卵巢保留的预测因素，并研究卵巢保留与早期宫颈癌年轻女性生存率的关系。这是一项回顾性队列研究，使用监测，流行病学和最终结果计划来确定1983年至2012年期间诊断为I期宫颈癌的基于子宫切除术的手术治疗患者（N= 16，511）。多变量模型用于确定与卵巢保护相关的独立因素。在9，419名年龄小于50岁的I期疾病妇女的亚组中，对3，908名（41.5%）在子宫切除术中接受卵巢保护而未接受放疗的妇女的生存结局和死亡原因进行了检查。多因素分析显示，年龄小于50岁、IA期和鳞状上皮是卵巢保留的独立相关因素（均P<0.01）。在5，526名年龄小于50岁的IA期患者中，接受子宫切除术而未接受放疗，接受卵巢保留术的患者的总生存率显著高于接受卵巢切除术的患者（20年生存率分别为93.5%和86.8%，P<0.001）;子宫颈癌特异性生存率在卵巢保留术和卵巢切除术患者之间相似（98.8%比97.8%，P= 0.12）。多因素分析显示，卵巢保留是提高总生存率的独立预后因素（校正的风险比0.63，95%置信区间[CI] 0.49-0.82，P=.001），与心血管疾病导致的死亡累积风险较低独立相关（20年累积发生率，1.2%对比3.3%，校正风险比0.47，95% CI 0.26-0.86，P= 0.014）和其他慢性疾病（0.5%对比1.4%，校正风险比0.24，95% CI 0.09-0.65，P= 0.005）。在3,893例年龄小于50岁的IB期子宫切除术但未接受放疗的妇女中，保留卵巢和卵巢切除术的宫颈癌特异性生存率（20年率，93.1%与92.0%，P= 0.37）和总生存率（86.7%与84.6%，P= 0.12）相似。在IA期宫颈癌的年轻女性中，子宫切除术时保留卵巢与降低全因死亡率相关，包括心血管疾病和其他慢性疾病导致的死亡。
To identify predictors of ovarian conservation at hysterectomy and to examine the association of ovarian conservation and survival of young women with early-stage cervical cancer. This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results Program to identify hysterectomy-based surgically treated patients with stage I cervical cancer diagnosed between 1983 and 2012 (N=16,511). Multivariable models were used to identify independent factors associated with ovarian conservation. Among the subgroup of 9,419 women younger than 50 years of age with stage I disease, survival outcomes and causes of death were examined for 3,908 (41.5%) women who underwent ovarian conservation at hysterectomy without radiotherapy. On multivariable analysis, age younger than 50 years, stage IA disease, and squamous histology were independent factors associated with ovarian conservation (all, P<001). Among 5,526 women younger than 50 years of age with stage IA disease who underwent hysterectomy without radiotherapy, overall survival was significantly higher in patients undergoing ovarian conservation than in those undergoing oophorectomy (20-year rate, 93.5% compared with 86.8%, P<.001); cervical cancer–specific survival was similar between the patients who underwent ovarian conservation and those who underwent oophorectomy (98.8% compared with 97.8%, P=.12). On multivariable analysis, ovarian conservation remained an independent prognostic factor for improved overall survival (adjusted hazard ratio 0.63, 95% confidence interval [CI] 0.49–0.82, P=.001) and was independently associated with lower cumulative risks of death resulting from cardiovascular disease (20-year cumulative rate, 1.2% compared with 3.3%, adjusted hazard ratio 0.47, 95% CI 0.26–0.86, P=.014) and other chronic disease (0.5% compared with 1.4%, adjusted hazard ratio 0.24, 95% CI 0.09–0.65, P=.005) compared with oophorectomy. Both cervical cancer-specific survival (20-year rate, 93.1% compared with 92.0%, P=.37) and overall survival (86.7% compared with 84.6%, P=.12) were similar between ovarian conservation and oophorectomy among 3,893 women younger than 50 years of age with stage IB disease who underwent hysterectomy without radiotherapy. Among young women with stage IA cervical cancer, ovarian conservation at hysterectomy is associated with decreased all-cause mortality including death resulting from cardiovascular disease and other chronic diseases.