ⅠB1期子宫颈癌不同年份肿瘤学结局的动态差异  

Dynamic differences in oncological outcomes of different years for stageⅠB2 cervical cancer patients

作　　者：兰俊 唐连 陈春林[3] 刘萍[3] LAN Jun;TANG Lian;CHEN Chun-lin;LIU Ping(不详;Department of Obstetric&Gy-necology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]东莞市妇幼保健院,东莞523000 [2]广州医科大学附属第三医院 [3]南方医科大学南方医院

出　　处：《妇产与遗传（电子版）》2022年第1期24-32,共9页Obstetrics-Gynecology and Genetics (Electronic Edition)

基　　金：国家科技支撑计划项目(2014BAI05B03);广东省自然科学基金(2015A030311024);广州市科技计划(158100075)。

摘　　要：目的动态调查ⅠB1期子宫颈癌接受腹腔镜及开腹手术后肿瘤学结局随年份变化的规律,并从术者经验角度分析其原因。方法回顾性收集中国大陆37家可独立开展子宫颈癌腹腔镜手术的医院住院患者的临床资料,对2004—2015年行腹腔镜或开腹手术的ⅠB1期宫颈癌患者的肿瘤学结局按年份进行对比分析,根据术者行第一例腹腔镜前的开腹例数,将不同手术经验者分为5组:1~31、31~60、61~90、91~120、121~180台,并用COX回归分析手术经验对腹腔镜术后肿瘤学结局的作用。结果以2009年为截点,在此之前腹腔镜、开腹手术ⅠB1期宫颈癌的5年OS呈一较稳定趋势,在此之后,则呈下降趋势。而2004—2015年腹腔镜和开腹手术ⅠB1期宫颈癌的5年DFS呈逐年上升趋势。手术经验是ⅠB1期宫颈癌腹腔镜手术治疗5年OS和DFS的独立影响因子(P=0.000)。2004—2009年、2010—2015年组腹腔镜组的5年OS随经验增长呈下降趋势,且不同手术经验组间有统计学差异(79.9%vs 95.9%,P=0.0041);2004—2009年、2010—2015年腹腔镜组的5年DFS无统计学差异(78.0%vs 84.0%,P=0.780)。结论ⅠB1期宫颈癌总体5年OS呈下降趋势,与腹腔镜手术量逐年上升呈反比,而与开腹手术量逐年下降呈正比。腹腔镜术后的肿瘤学结局随手术经验的增加反而更差。Objective To explore the rules of oncological outcomes of different years after lapa⁃roscopy and open surgery for stageⅠB1 cervical cancer patients and to analyze the reasons from sur⁃geon's perspective.Methods The clinical data of stageⅠB1 patients underwent laparoscopic(LRH)and abdominal(ARH)surgery from 2004 to 2015 in 37 hospitals of China's Mainland that can independently carry out laparoscopic surgery for cervical cancer were retrospectively collected.Differ⁃ences in 5⁃year overall survival(OS)and 5⁃year disease⁃free survival(DFS)between two surgical ap⁃proaches were compared and analyzed.According to the number of ARH surgery before the first LRH surgery,surgeons were divided into 5 groups:1~30,31~60,61~90,91~120,121~180,and the effect of surgical experience on postoperative oncological outcomes after LRH surgery was analyzed by COX regression.Results Taking 2009 as the cut⁃off point,the 5⁃year OS of LRH and ARH surgery of stageⅠB1 cervical cancer showed a relatively stable trend,while after 2009,it showed a declining trend.However,from 2004 to 2015,the DFS of stageⅠB1 cervical cancer underwent LRH and ARH surgery were all increased year by year.Surgical experience was an independent impact factor for both 5⁃year laparoscopic OS and DFS inⅠB1 stage cervical cancer(P=0.000).The 5⁃year OS of the LRH group from 2004~2009 and 2010~2015 showed a decreasing trend with the increase of experi⁃ence,and there was statistical significance between the groups with different surgical experience(79.9%vs 95.9%,P=0.0041).The 5⁃year DFS of the LRH group had no statistical significance between 2004~2009 and 2010~2015(78.0%vs 84.0%,P=0.780).Conclusions the overall OS of stageⅠB1 cervical cancer decreased in 5 years,which was inversely proportional to the increase of LRH surgery and positively proportional to the decrease of ARH surgery.The oncological outcome of LRH surgery is worse with the increase of surgical experience.

关 键 词：宫颈肿瘤 开腹 腹腔镜 肿瘤学结局 手术经验 

分 类 号：R737[医药卫生—肿瘤]