基于大数据探讨ⅠB2期子宫颈癌腹腔镜与开腹手术长期肿瘤学结局研究  

Long-term oncological outcomes of laparoscopic versus abdominal surgery for stage Ⅰ B2 cervical cancer patients——a study based on big data

作　　者：陈春林[1] 倪妍 陈嘉铭 段慧[1] 王倩青[3] 王绍光[4] 戴恩成[5] 郝敏[6] 王中海[7] 凌斌[8] 唐连 姜文轩 宾晓农 郎景和[10] 刘萍[1] CHEN Chun-lin;NI Yan;CHEN Jia-ming;DUAN Hui;WANG Qian-qing;WANG Shao-guang;DAI En-cheng;HAO Min;WANG Zhong-hai;LING Bin;TANG Lian;JIANG Wen-xuan;BIN Xiao-nong;LANG Jing-he;LIU Ping(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;不详)

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]运城市中心医院妇产科,山西运城044000 [3]新乡市中心医院妇科,河南新乡453000 [4]烟台毓璜顶医院妇科,山东烟台264000 [5]临沂市人民医院妇产科,山东临沂276003 [6]山西医科大学第二医院妇产科,山西太原030001 [7]深圳市南山区人民医院妇产科,广东深圳518052 [8]中日友好医院妇产科,北京100029 [9]广州医科大学公共卫生学院,广东广州511436 [10]中国医学科学院北京协和医院妇产科,北京100730

出　　处：《中国实用妇科与产科杂志》2020年第10期982-989,共8页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：十二五国家科技支撑计划(2014BAI05B03);国家自然科学基金(81272585);广州市科技计划(158100075);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启动项目(LC2016ZD019)。

摘　　要：目的应用大数据探讨中国ⅠB2期子宫颈癌患者腹腔镜与开腹手术的长期肿瘤学结局差异。方法基于中国子宫颈癌临床诊疗大数据库,回顾性分析2009—2016年国内部分地区ⅠB2期子宫颈癌腹腔镜与开腹手术病例,通过真实世界研究(RWS)和倾向评分匹配(PSM)的方法,分析2种手术途径5年总体生存率(OS)和无病生存率(DFS)的差异。结果(1)初始入组共纳入2176例病例,其中腹腔镜组646例,开腹组1530例。匹配前两组5年OS差异无统计学意义(82.5%vs.88.4%,P=0.060),但5年DFS腹腔镜组低于开腹组(77.6%vs.83.9%,P=0.001),Cox比例风险模型分析显示腹腔镜手术是患者5年死亡和复发/死亡的独立危险因素(OS:HR=1.398,95%CI 1.029~1.898,P=0.032;DFS:HR=1.540,95%CI 1.220~1.943,P<0.001)。1∶2 PSM匹配后共纳入1575例病例,其中腹腔镜组525例,开腹组1050例;腹腔镜组的5年OS和DFS均低于开腹组(OS:82.4%vs.89.2%,P=0.042;DFS:77.6%vs.85.0%,P=0.001),Cox比例风险模型分析显示腹腔镜手术是患者5年死亡和复发/死亡的独立危险因素(OS:HR=1.457,95%CI 1.022~2.077,P=0.037;DFS:HR=1.569,95%CI 1.198~2.054,P=0.001)。(2)进一步限定手术类型为QM-B型或QM-C型子宫切除为纳入条件,共入组2066例病例,其中腹腔镜组627例,开腹组1439例;匹配前两组的5年OS差异无统计学意义(82.1%vs.88.2%,P=0.056),但5年DFS腹腔镜组低于开腹组(77.5%vs.83.6%,P=0.001),Cox比例风险模型分析显示腹腔镜手术是患者5年死亡和复发/死亡的独立危险因素(OS:HR=1.421,95%CI 1.044~1.935,P=0.025;DFS:HR=1.529,95%CI 1.207~1.938,P<0.001)。1∶2 PSM匹配后共纳入1470例病例,其中腹腔镜组490例,开腹组980例;两组的5年OS差异无统计学意义(83.2%vs.88.8%,P=0.126),但5年DFS腹腔镜组低于开腹组(77.5%vs.84.7%,P=0.001),Cox比例风险模型显示腹腔镜手术仅是患者5年复发/死亡的独立危险因素(HR=1.575,95%CI 1.191~2.081,P=0.001)。结论ⅠB2期子宫颈癌患者腹腔镜手术与开腹手术相�Objective To compare the long-term oncological outcomes between laparoscopic(LRH) and abdominal(ARH) surgery in Chinese patients with stage I B2 cervical cancer based on big data.Methods Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China,we analyzed the LRH and ARH cases of stage I B2 cervical cancer from 2009 to 2016 in China retrospectively.Differences in 5-year overall survival(OS)and 5-year disease-free survival(DFS) between two surgical approaches were analyzed by real world study(RWS) and propensity score matching(PSM).Results(1) A total of 2176 patients were enrolled in initial analysis,including 646 patients in LRH group and 1530 patients in ARH group.Before matching,there was no difference in 5-year OS between two groups(82.5% vs.88.4%,P=0.060),but LRH had lower 5-year DFS(77.6% vs.83.9%,P=0.001).Cox proportional hazard model analysis suggested LRH was an independent risk factor for death and recurrence/death(OS:HR=1.398,95%CI1.029-1.898,P=0.032;DFS:HR=1.540,95%CI 1.220-1.943,P<0.001).After 1:2 ratio matching,1575 patients were included,with 525 patients in LRH group and 1050 patients in ARH group.The 5-year OS and DFS in LRH were both lower than those of ARH(OS:82.4% vs.89.2%,P=0.042;DFS:77.6% vs.85.0%,P=0.001).Cox proportional hazard model analysis showed LRH was an independent risk factor for death and recurrence/death(OS:HR=1.457,95% CI1.022-2.077,P=0.037;:DFS:HR=1.569,95 % CI 1.198-2.054,P=0.001).(2) A total of 2066 patients with QM-B or QM-C hysterectomy were further enrolled,including 627 patients in LRH group and 1439 patients in ARH group.Before matching,there was no difference in 5-year OS between two group(82.1 % vs.88.2%,P=0.056),but 5-year DFS in LRH was lower(77.5% vs.83.6%,P=0.001).Cox proportional hazard model analysis suggested LRH was an independent risk factor for death and recurrence/death(OS:HR=1.421,95%CI 1.044-1.935,P=0.025;DFS:HR=1.529,95%CI 1.201-1.938,P<0.001).After 1:2 ratio matching,1470 patients were included,with 490 patients in LRH gro

关 键 词：子宫颈肿瘤 腹腔镜手术 开腹手术 肿瘤学结局 真实世界研究 

分 类 号：R741.433[医药卫生—神经病学与精神病学]