不同肿瘤直径的Ⅰa1(LVSI阳性)~Ⅰb1期子宫颈癌腹腔镜与开腹手术的肿瘤学结局比较  

Long-term oncological outcomes of laparoscopic versus abdominal surgery in stageⅠa1(LVSI+)-Ⅰb1 cervical cancer patients with different tumor size:a big database in China

作　　者：陈春林[1] 康山 陈必良 杨鹰 郭建新 郝敏[6] 王武亮[7] 纪妹[8] 孙立新[9] 王莉[10] 梁文通[11] 王绍光[12] 李维丽[1] 范辉健 刘萍[1] 郎景和[13] Chen Chunlin;Kang Shan;Chen Biliang;Yang Ying;Guo Jianxin;Hao Min;Wang Wuliang;Ji Mei;Sun Lixin;Wang Li;Liang Wentong;Wang Shaoguang;Li Weili;Fan Huijian;Liu Ping;Lang Jinghe(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Gynecology,Fourth Hospital,Hebei Medical University,Shijiazhuang 050011,China;Department of Gynecology,Xijing Hospital,Air Force Medical University,Xi′an 710032,China;Department of Obstetrics and Gynecology,Xinqiao Hospital,Army Medical University,Chongqing 400037,China;Department of Obstetrics and Gynecology,Daping Hospital,Army Medical University,Chongqing 400042,China;Department of Obstetrics and Gynecology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Obstetrics and Gynecology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Gynecology,Shanxi Cancer Hospital,Taiyuan 030013,China;Department of Gynecology,Henan Cancer Hospital,Zhengzhou 450008,China;Department of Gynecology,Guizhou Provincial People′s Hospital,Guiyang 550002,China;Department of Gynecology,Yantai Yuhuangding Hospital,Qingdao University,Yantai 264000,China;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]南方医科大学南方医院妇产科,广州510515 [2]河北医科大学第四医院妇科,石家庄050011 [3]空军军医大学西京医院妇科,西安710032 [4]陆军军医大学新桥医院妇产科,重庆400037 [5]陆军军医大学大坪医院妇产科,重庆400042 [6]山西医科大学第二医院妇产科,太原030001 [7]郑州大学第二附属医院妇产科,450014 [8]郑州大学第一附属医院妇产科,450052 [9]山西省肿瘤医院妇科,太原030013 [10]河南省肿瘤医院妇科,郑州450008 [11]贵州省人民医院妇科,贵阳550002 [12]青岛大学附属烟台毓璜顶医院妇科,264000 [13]中国医学科学院北京协和医院妇产科,100730

出　　处：《中华妇产科杂志》2020年第9期589-599,共11页Chinese Journal of Obstetrics and Gynecology

基　　金：国家科技支撑计划(2014BAI05B03);国家自然科学基金(81272585);广州市科技计划(201508020264);广东省教育厅高水平大学建设经费南方医科大学临床研究重点项目(LC2016ZD019)。

摘　　要：目的比较不同肿瘤直径的Ⅰa1[淋巴脉管间隙浸润(LVSI)阳性]~Ⅰb1期[按照国际妇产科联盟(FIGO 2009)的分期标准]子宫颈癌患者腹腔镜手术与开腹手术的长期肿瘤学结局的差异。方法(1)基于中国子宫颈癌临床诊疗大数据项目,纳入2009年1月1日—2016年12月31日符合入组条件的Ⅰa1(LVSI阳性)~Ⅰb1期子宫颈癌患者行腹腔镜手术(腹腔镜组)与开腹手术(开腹组)的患者,进行1∶1倾向性评分匹配(PSM)方法匹配,比较匹配前、后两组患者的肿瘤学结局。(2)将纳入的Ⅰa1(LVSI阳性)~Ⅰb1期子宫颈癌手术患者,进一步根据肿瘤直径的不同分为4层,即肿瘤直径≤1 cm、>1~2 cm、>2~3 cm、>3~4 cm,并在每个分层中分别对腹腔镜与开腹组进行1∶1 PSM方法匹配,比较不同肿瘤直径的两组患者的肿瘤学结局。肿瘤学结局的评价指标为5年总生存率(OS)及5年无瘤生存率(DFS)。结果(1)本研究纳入Ⅰa1(LVSI阳性)~Ⅰb1期子宫颈癌腹腔镜、开腹手术患者共4891例,其中腹腔镜组1926例,开腹组2965例。PSM方法匹配前,腹腔镜组、开腹组患者的5年OS分别为94.1%、94.0%,5年DFS分别为89.1%、90.7%,两组分别比较,差异均无统计学意义(P=0.971,P=0.165);多因素分析(Cox风险比例回归模型)显示,腹腔镜手术是影响子宫颈癌患者5年DFS的独立危险因素(HR=1.367,95%CI为1.105~1.690,P=0.004)。经1∶1 PSM方法匹配后,腹腔镜组、开腹组各纳入1864例,两组患者的5年OS(分别为94.1%、95.4%)比较无显著差异(P=0.151),但腹腔镜组的5年DFS显著低于开腹组(分别为89.0%、92.3%,P=0.004);多因素分析显示,腹腔镜手术是影响子宫颈癌患者5年DFS的独立危险因素(HR=1.420,95%CI为1.109~1.818,P=0.006)。(2)在不同肿瘤直径的分层分析中,腹腔镜组与开腹组的5年OS及5年DFS在肿瘤直径≤1 cm、>1~2 cm、>2~3 cm的3个分层中均无显著差异(P>0.05);多因素分析显示,手术途径不是影响子宫颈癌患者5年OS和5年DFS的�Objective To compare the long-term oncological outcomes between laparoscopic and abdominal surgery in stageⅠa1(lymph-vascular space invasion-positive,LVSI+)-Ⅰb1 cervical cancer patients with different tumor sizes.Methods Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China(1538 project database),patients with stageⅠa1(LVSI+)-Ⅰb1 cervical cancer who treated by laparoscopic or abdominal surgery were included.The 5-year overall survival(OS)and 5-year disease-free survival(DFS)between the two surgical approaches were compared under 1∶1 propensity score matching(PSM)in different tumor diameter stratification.Results(1)A total of 4891 patients with stageⅠa1(LVSI+)-Ⅰb1 cervical cancer who underwent laparoscopy or laparotomy from January 1,2009 to December 31,2016 were included in the 1538 project database.Among them,1926 cases in the laparoscopic group and 2965 cases in the abdominal group.There were no difference in 5-year OS and 5-year DFS between the two groups before matching.Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS(HR=1.367,95%CI:1.105-1.690,P=0.004).After 1∶1 PSM matching,1864 patients were included in each group,and there was no difference in 5-year OS between the two groups(94.1%vs 95.4%,P=0.151).While,the inferior 5-year DFS was observed in the laparoscopic group(89.0%vs 92.3%,P=0.004).And the laparoscopic surgery was associated with lower 5-year DFS(HR=1.420,95%CI:1.109-1.818,P=0.006).(2)In stratification analysis of different tumor sizes,and there were no difference in 5-year OS and 5-year DFS between the laparoscopic group and abdominal group in tumor size≤1 cm,>1-2 cm and>2-3 cm stratification(all P>0.05).Cox multivariate analysis showed that laparoscopic surgery were not related to 5-year OS and 5-year DFS(P>0.05).In the stratification of tumor size>3-4 cm,there was no difference in 5-year OS between the two groups(P>0.05).The 5-year DFS in the laparoscopic group was worse than that in the abdom

关 键 词：宫颈肿瘤 腹腔镜手术 剖腹术 治疗结果 预后 

分 类 号：R737.33[医药卫生—肿瘤]