The potential for de-escalation radical surgery in women with stage IB2 cervical cancer (FIGO 2018): a multi-institutional experience of 63,926 cases over a 14-year period in China.
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引用次数: 0
Abstract
Objective: To compare the long-term survival outcomes, recurrence patterns and morbidity of type B and type C radical hysterectomy (RH) for stage IB2 cervical cancer (FIGO 2018).
Methods: Based on FOUR-C database, patients who underwent type B or C RH in 47 hospitals from 2004 to 2018 were reviewed. Univariate and multivariate analyses were performed to compare 5-year overall survival (OS) and recurrence-free survival (RFS), recurrence patterns and morbidity between the two groups after propensity score matching (PSM).
Results: A total of 1308 patients were enrolled in this study, 840 and 468 patients underwent type B and type C. There was no difference in 5-year survival outcomes between groups type B and type C, either before or after matching (OS: unmatched 95.6% vs. 93.3%, matched 95.6 vs. 93.0%, P>0.05; RFS: unmatched: 90.5% vs. 90.1%, matched: 91.2% vs. 89.7%, P>0.05). Type B group had a shorter operative time, less blood loss, earlier recovery of intestinal function, eariler removal of catheter and shorter hospitalization (P<0.01). Intraoperative complications were similar (0.1% vs. 0.2%, P>0.05), but postoperative complications occurred more frequently in the type C group (8.3% vs. 12.1%, P < 0.05), especially lymphocysts and urinary retention. The surgical dissection does not appear to influence tumor recurrences significantly (P>0.05).
Conclusions: For cervical cancer patients with stage IB2, type B RH demonstrated comparable long-term oncological outcomes and recurrence patterns to type C RH, while being associated with fewer intra-and postoperative complications. Type B RH is a feasible and appropriate surgical option, but the conclusions need to be confirmed by prospective studies.
目的:比较B型和C型根治性子宫切除术(RH)治疗IB2期宫颈癌的长期生存结局、复发模式和发病率(FIGO 2018)。方法:基于FOUR-C数据库,对2004 - 2018年47家医院B型或C型RH患者进行回顾性分析。采用单因素和多因素分析比较倾向评分匹配(PSM)后两组患者的5年总生存率(OS)和无复发生存率(RFS)、复发模式和发病率。结果:本研究共纳入1308例患者,其中B型和C型患者分别为840例和468例。B型组和C型组在配对前后的5年生存结局无差异(OS:未配对95.6% vs. 93.3%,配对95.6% vs. 93.0%, P < 0.05;RFS:未匹配:90.5% vs. 90.1%,匹配:91.2% vs. 89.7%, P < 0.05)。B型组手术时间短、出血量少、肠功能恢复早、拔管早、住院时间短(P0.05),但C型组术后并发症发生率较高(8.3%比12.1%,P0.05)。结论:对于IB2期宫颈癌患者,B型RH表现出与C型RH相当的长期肿瘤预后和复发模式,同时与更少的术后并发症相关。B型RH是一种可行和合适的手术选择,但结论需要通过前瞻性研究来证实。