Oncological Outcomes After Okabayashi-Kobayashi Radical Hysterectomy for Early and Locally Advanced Cervical Cancer
Oncological Outcomes After Okabayashi-Kobayashi Radical Hysterectomy for Early and Locally Advanced Cervical Cancer
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DOI：
10.1001/jamanetworkopen.2020.4307
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发表时间：
2020-05-07
影响因子：
13.8
通讯作者：
Watari, Hidemichi
中科院分区：
文献类型：
--
作者：
Sakuragi, Noriaki;Kato, Tatsuya;Watari, Hidemichi
本队列研究评估了局部晚期宫颈癌的根治性子宫切除术和宫颈旁组织的广泛切除是否与令人满意的肿瘤结果相关。根治性子宫切除术加宫颈旁组织的扩大切除是否与局部晚期宫颈癌的满意结果相关？本研究对121例行Okabayashi-Kobayashi根治性子宫切除术的宫颈癌患者进行回顾性队列研究，发现早期IB1/IIA1疾病和局部晚期IB2/IIA2/IIB疾病的5年局部控制率分别为99%和87%，5年总生存率分别为95%和82%。意义除了放疗/放化疗外，冈林-小林根治性子宫切除术联合辅助化疗可能是局部晚期宫颈癌的治疗选择。手术在早期宫颈癌中的作用已经确立，但在局部晚期宫颈癌中的作用仍存在争议。目的探讨宫颈旁组织扩大切除根治性子宫切除术治疗局部晚期宫颈癌是否能获得满意的预后。设计、环境和参与者本回顾性队列研究于2002年1月1日至2011年12月31日进行，参与者为日本北部单一三级中心的宫颈癌患者。中位随访时间为106个月，没有患者在60个月以下失去随访。数据分析时间为2017年7月1日至2018年12月31日。患者接受根治性子宫切除术采用Okabayashi-Kobayashi方法。IB1/IB2期采用双侧神经保留，IIA/IIB期采用单侧神经保留。复发中高风险患者选择化疗作为辅助治疗，部分患者选择或被分配放疗。主要结局指标为5年局部控制率、5年总生存率及危险因素分析。结果121例患者中，76例（62.8%）在2008年国际妇产科联合会IB1和IIA1分期为早期宫颈癌，45例（37.2%）在IB2、IIA2和IIB分期为局部晚期宫颈癌。年龄中位数（范围）为42岁（26-68岁）。2例（3%）早期宫颈癌患者和3例（7%）局部晚期宫颈癌患者采用辅助放疗。早期宫颈癌和局部晚期宫颈癌5年局部控制率分别为99%和87%。早期宫颈癌和局部晚期宫颈癌的5年总生存率分别为95%和82%。Cox回归分析显示，淋巴结转移和腺（鳞）癌组织学是影响宫颈癌根治性子宫切除术患者总生存率的独立危险因素。结论与意义在已发表的文献中，保留神经的Okabayashi-Kobayashi根治性子宫切除术治疗局部晚期宫颈癌的生存率不低于根治性子宫切除术或放疗。根治性子宫切除术联合辅助化疗治疗局部晚期宫颈癌的适用性有待于前瞻性比较试验的验证。
This cohort study assesses whether a radical hysterectomy method with extended removal of paracervical tissue for locally advanced cervical cancer is associated with satisfactory oncological outcomes.Question Is radical hysterectomy with extended removal of paracervical tissue associated with satisfactory outcomes for locally advanced cervical cancer? Findings This retrospective cohort study of 121 patients with cervical cancer treated with Okabayashi-Kobayashi radical hysterectomy showed that the 5-year local control rates for early-stage IB1/IIA1 disease and locally advanced stage IB2/IIA2/IIB disease were 99% and 87%, respectively, and the 5-year overall survival rates for these groups were 95% and 82%, respectively. Meaning Okabayashi-Kobayashi radical hysterectomy with adjuvant chemotherapy may be a treatment option for locally advanced cervical cancer besides radiotherapy/chemoradiotherapy.Importance The role of surgery in early-stage cervical cancer has been established, but it is controversial in locally advanced cervical cancer. Objective To determine whether a radical hysterectomy method with extended removal of paracervical tissue for locally advanced cervical cancer is associated with satisfactory oncological outcomes. Design, Setting, and Participants This retrospective cohort study was conducted from January 1, 2002, to December 31, 2011, and participants were patients with cervical cancer at a single tertiary center in Northern Japan. The median follow-up period was 106 months, and none of the patients were lost to follow-up at less than 60 months. Data analyses were performed from July 1, 2017, to December 31, 2018. Exposures Patients underwent radical hysterectomy using the Okabayashi-Kobayashi method. Bilateral nerve preservation was used for stage IB1/IB2 disease and unilateral nerve preservation for stage IIA/IIB if disease extension outside the uterine cervix was 1-sided. Chemotherapy was used as the choice of adjuvant treatment for patients with an intermediate or high risk of recurrence, while some patients chose or were assigned to radiotherapy. Main Outcomes and Measures Primary outcomes were the 5-year local control rate and 5-year overall survival rate along with risk factor analysis. Results Of 121 consecutive patients, 76 (62.8%) had early-stage cervical cancer in 2008 International Federation of Gynecology and Obstetrics stages IB1 and IIA1 and 45 (37.2%) had locally advanced cervical cancer in stages IB2, IIA2, and IIB. The median (range) age was 42 (26-68) years. Adjuvant radiotherapy was used in 2 patients (3%) with early-stage cervical cancer and 3 (7%) of those with locally advanced cervical cancer. The 5-year local control rates for early-stage cervical cancer and locally advanced cervical cancer were 99% and 87%, respectively. The 5-year overall survival rates for early-stage cervical cancer and locally advanced cervical cancer were 95% and 82%, respectively. Cox regression analysis showed that lymph node metastasis and histology of adeno(squamous)carcinoma were independent risk factors for the overall survival of patients with cervical cancer treated with radical hysterectomy. Conclusions and Relevance The nerve-sparing Okabayashi-Kobayashi radical hysterectomy for locally advanced cervical cancer may provide survival not inferior to radical hysterectomy or radiotherapy in published literature. The applicability of radical hysterectomy with adjuvant chemotherapy for locally advanced cervical cancer needs to be validated by prospective comparative trials.