宫颈癌患者行腹式开放式根治性子宫切除术的术前锥化：来自倾向评分匹配研究的结果

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-04-02 DOI:10.1016/j.ygyno.2025.03.031

Benjamin Wolf , Dimitra Sofia Trantaki , Lars-Christian Horn , Bahriye Aktas , Nadja Dornhöfer

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引用次数: 0

摘要

目的宫颈切除术是宫颈癌的常用诊断手段，但其对腹部根治性子宫切除术前预后的影响尚不清楚。本研究探讨圆锥切除术对早期和晚期宫颈癌预后的影响，圆锥标本切除边缘的意义，以及子宫切除术后圆锥切除术时间的影响。方法回顾性分析Leipzig Mesometrial Resection （MMR）试验中IB1-IIB期原发性宫颈癌患者的资料（2009-FIGO）。经腹剖腹根治性子宫切除术作为全子宫系膜切除术或延伸性子宫系膜切除术（TMMR/EMMR）。采用Kaplan-Meier法和Cox比例风险回归模型进行倾向评分匹配和生存比较。结果542例患者中，202例在诊断时出现锥突。1:1倾向评分匹配后（每组163例患者），术前锥化与更好的无复发相关(95.6%比82.3%,HR 3.2, 95% CI 1.4-7.0, p <；0.01)和整体(99.2%比85.6%,人力资源6.3,95%可信区间1.9 - -21.1,p & lt;0.001)的生存。在多变量Cox回归模型中，锥形化独立提高无复发生存率(HR 0.3, 95% CI 0.1-0.6, p <；0.01)。无锥化的远处复发累积风险显著增高（sHR 14.9, 95% CI 1.9 ~ 114.9, p = 0.01），而局部复发无差异。锥形切除肿瘤的完整性（R-status）对预后没有影响。迟发根治性子宫切除术≥28天与总生存率相关（p = 0.02）。结论：不论切除边缘、淋巴结状态或相关累及程度如何，行腹式开放式根治性子宫切除术的宫颈癌患者术前切除与生存率提高相关。迟延根治性子宫切除术≥28天，进一步提高了生存率，减少了远处转移。

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Preoperative conization in cervical cancer patients undergoing open abdominal radical hysterectomy: Results from a propensity-score matched study

Objective

Conization is a common diagnostic tool in cervical cancer, but its prognostic impact prior to abdominal radical hysterectomy remains unclear. This study examines conization's influence on outcomes in early and advanced cervical cancer, the significance of cone specimen resection margins, and the impact of hysterectomy timing post-conization.

Methods

Data from the Leipzig Mesometrial Resection (MMR) trial were retrospectively analyzed for patients with primary cervical cancer staged IB1-IIB (2009-FIGO). Open abdominal radical hysterectomy was performed as total or extended mesometrial resection (TMMR/EMMR). Propensity score matching and survival comparisons were conducted using the Kaplan-Meier method and Cox proportional hazards regression modeling.

Results

Among 542 patients, 202 had conization during diagnostic workup. After 1:1 propensity score matching (163 patients per group), preoperative conization was associated with better recurrence-free (95.6 % vs. 82.3 %, HR 3.2, 95 % CI 1.4–7.0, p < 0.01) and overall (99.2 % vs. 85.6 %, HR 6.3, 95 % CI 1.9–21.1, p < 0.001) survival. In a multivariable Cox regression model, conization independently improved recurrence-free survival (HR 0.3, 95 % CI 0.1–0.6, p < 0.01). The cumulative risk of distant recurrence was significantly higher without conization (sHR 14.9, 95 % CI 1.9–114.9, p = 0.01), with no difference in local recurrences. Completeness of tumor removal by conization (R-status) had no prognostic impact. Delayed radical hysterectomy ≥28 days post-conization was associated with improved overall survival (p = 0.02).

Conclusion

Preoperative conization was associated with improved survival in cervical cancer patients undergoing open abdominal radical hysterectomy, irrespective of resection margin, nodal status, or parametrial involvement. Delaying radical hysterectomy by ≥28 days post-conization further enhanced survival and reduced distant metastases.

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy