2018年FIGO子宫颈癌新分期中ⅠB1期治疗策略的探讨  

Exploration of treatment strategies for stageⅠB1 in the new 2018 FIGO cervical cancer staging

作　　者：柳攀 龚时鹏[1] 黎志强[1] 孙立新[2] 崔竹梅[3] 康山 纪妹[5] 陈必良 赵卫东[7] 宾晓农 刘萍[1] 郎景和 陈春林[1] LIU Pan;GONG Shi-peng;LI Zhi-qiang;SUN Li-xin;CUI Zhu-mei;KANG Shan;JI Mei;CHEN Bi-liang;ZHAO Wei-dong;BIN Xiao-nong;LIU Ping;LANG Jing-he;CHEN Chun-lin(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]山西省肿瘤医院妇科,山西太原030001 [3]青岛大学附属医院妇产科,山东青岛266000 [4]河北医科大学第四医院妇科,河北石家庄050000 [5]郑州大学第一附属医院妇产科,河南郑州450052 [6]空军军医大学西京医院妇科,陕西西安710032 [7]中国科学技术大学附属第一医院(安徽省立医院)妇产科,安徽合肥230001 [8]广州医科大学公共卫生学院,广东广州511436 [9]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》2021年第8期836-840,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：十二五国家科技支撑计划(2014BAI05B03);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：目的探讨FIGO 2018新分期ⅠB1期子宫颈癌合适的治疗策略。方法基于中国子宫颈癌临床诊疗项目大数据库,筛选FIGO 2018新分期ⅠB1期子宫颈癌患者,采用整体队列及倾向评分匹配(PSM 1∶1)的方法,比较行腹腔镜和开腹两种手术途径子宫颈癌患者的5年总体生存率(OS)和无瘤生存率(DFS)。结果(1)纳入符合入组条件的FIGO 2018ⅠB1期子宫颈癌患者3391例,其中腹腔镜组1436例,开腹组1955例,中位随访时间39个月(腹腔镜vs.开腹组:34个月vs.56个月);PSM 1∶1匹配后两组分别纳入1336例,中位随访时间38个月(腹腔镜组vs.开腹组:33个月vs.55个月)。(2)整体队列中腹腔镜组与开腹组的5年OS和DFS差异无统计学意义(OS:97.8%vs.97.8%,P=0.715;DFS:93.9%vs.94.6%,P=0.205);Cox分析腹腔镜手术不是患者死亡及复发/死亡的独立危险因素(OS:HR=1.172,95%CI 0.631~2.179,P=0.615;DFS:HR=0.81,95%CI 0.572~1.148,P=0.237)。(3)PSM1∶1匹配后腹腔镜组与开腹组的5年OS和DFS亦差异无统计学意义(OS:97.8%vs.97.8%,P=0.844;DFS:93.7%vs.93.8%,P=0.492);Cox分析腹腔镜手术亦不是患者死亡及复发/死亡的独立危险因素(OS:HR=1.058,95%CI0.535~2.090,P=0.871;DFS:HR=0.861,95%CI 0.593~1.252,P=0.434)。结论从肿瘤学结局角度分析,FIGO2018新分期ⅠB1期子宫颈癌患者腹腔镜与开腹手术的肿瘤学结局未见差异,腹腔镜广泛性子宫切除术可应用于FIGO 2018ⅠB1期子宫颈癌患者的治疗。Objective To explore appropriate treatmentstrategies for FIGO 2018 new staging of stageⅠB1 cervical cancer from an oncology outcome perspective.Methods Based on a large database of Chinese cervicalcancer clinical treatment programs,patients with FIGO2018 new stageⅠB1 cervical cancer were screened andthe overall study population and propensity scorematching(PSM 1∶1)were used to compare the 5-yearoverall survival(OS)and disease-free survival(DFS)ofpatients with cervical cancer who underwent operationsby laparoscopic and open surgical routes.Results(1)Totally 3391 patients with FIGO 2018 stageⅠB1 cervical cancer who met the inclusion criteria wereincluded,including 1436 in the laparoscopic group and1955 in the open group,with a median follow-up of 39 months(laparoscopic vs.open group:34 months vs.56 months);1336 patients were included in each of the two groupsafter PSM 1∶1 matching,with a median follow-up of 38 months(laparoscopic group vs.open group:33 months vs.55 months).(2)The differences in 5-year overall survival(OS)and tumor-free survival(DFS)between the laparoscopic andopen groups before matching were not statistically significant(OS:97.8%vs.97.8%,P=0.715;DFS:93.9%vs.94.6%,P=0.205);Cox analysis showed that laparoscopic surgery was not an independent risk factor for patient death andrecurrence/death(OS:HR=1.172,95%CI 0.631-2.179,P=0.615;DFS:HR=0.81,95%CI 0.572-1.148,P=0.237).(3)The differences in 5-year OS and DFS between the laparoscopic and open groups after PSM1∶1 matching were also notstatistically significant(OS:97.8%vs.97.8%,P=0.844;DFS:93.7%vs.93.8%,P=0.492);Cox analysis showed thatlaparoscopic surgery was also not an independent risk factor for patient death and recurrence/death(OS:HR=1.058,95%CI 0.535-2.090,P=0.871;DFS:HR=0.861,95%CI 0.593-1.252,P=0.434).ConclusionFrom the perspective ofoncologic outcomes,there is no statistically significant difference in oncologic outcomes between laparoscopic and opensurgery in patients with FIGO 2018 new stageⅠB1 cervical cancer,and laparoscopic ext

关 键 词：子宫颈肿瘤 FIGO 2018ⅠB1期 腹腔镜手术 开腹手术 肿瘤学结局 

分 类 号：R737.3[医药卫生—肿瘤]