Ⅰ型及Ⅲ型根治性全子宫切除术在Ⅰb1期宫颈癌(肿瘤直径≤2cm)中的配对研究

Class Ⅰ versus Class Ⅲ radical hysterectomy in stage Ⅰb1( diameter of tumor≤2cm) cervical cancer: a matched cohort study

目的:研究肿瘤直径≤2cm的Ⅰb1期宫颈癌患者行Ⅰ型全子宫切除术及Ⅲ型根治性全子宫切除术的手术结局和长期肿瘤结局。方法:回顾分析2002年5月至2016年5月在中山大学附属第一医院妇科因Ⅰb1期宫颈癌(肿瘤直径≤2cm)行腹腔镜下Ⅰ型全子宫切除术+盆腔淋巴结切除术和Ⅲ型根治性全子宫切除术+盆腔淋巴结切除术的患者的临床资料,其中Ⅰ型组70例,Ⅲ型组577例。根据肿瘤复发危险因素配对两组患者,再通过贪婪算法比较两组的手术情况及术后长期肿瘤学结局。5年生存率采用Kaplan-Meier曲线评价。结果:70对患者形成配对(Ⅰ型组:Ⅲ型组),Ⅰ型全子宫切除术患者的中位随访时间为75月(27~168月),Ⅲ型根治性全子宫切除术患者的中位随访时间为75月(26~170月)。两组的5年无复发生存率(RFS)(98.6%vs 97.1%,P=0.56)和总体生存率(100.0%vs 98.5%,P=0.32)比较,差异无统计学意义。与Ⅲ型组比较,Ⅰ型组的手术时间更短,术中失血量更少,术中及术后并发症更少,住院天数更短。结论:肿瘤直径≤2cm的Ⅰb1期宫颈癌选用Ⅰ型全子宫切除术和Ⅲ型根治性全子宫切除术的疗效相同,且Ⅰ型全子宫切除术围术期的并发症更少,患者术后康复更快。

Objective： To compare the surgical and long-term oncological outcomes of Class Ⅰ hysterectomy and Class Ⅲ radical hysterectomy for treatment of stage Ⅰb1 cervical cancer（ diameter of tumor ≤2 cm）. Methods： A retrospective cohort study over a 14-year period（ May.2002~ May.2016） was conducted,collecting clinicopathologic and follow-up data to compare the surgical and long-term oncological outcomes.70 patients underwent Class Ⅰ hysterectomy and 577 patients underwent Class Ⅲ radical hysterectomy with stage Ⅰb1 cervical cancer patients（ diameter of tumor≤2 cm）,all of them were matched with known risk factors for recurrence by greedy algorithm. Five-year survival outcomes were assessed by using Kaplan-Meier model.Results： After matching,a total of 70 patient pairs（ Class I-Class Ⅲ） were included.The median follow-up times were 75（ range 26 ~ 170） months in the Class Ⅲ group and 75（ range27 ~ 168） months in the Class Ⅰ group.The Class Ⅰ and Class Ⅲ group had similar 5-year recurrence-free survival rates（ RFS）（ 98.6% vs 97.1%,P = 0.56） and overall survival rates（ OS）（ 100.0% vs 98.5%,P = 0.32）.Compared with the Class Ⅲ group,the Class Ⅰ group resulted in significantly shorter operating time,less intra-operative blood loss,less intraoperative complications,less postoperative complications,and shorter hospital stay.Conclusions： Class Ⅰ hysterecto-my is an oncological safe alternative to Class Ⅲ radical hysterectomy in treatment of stage Ⅰb1 cervical cancer（ diameter of tumor ≤2 cm） and Class Ⅰ hysterectomy is associated with fewer perioperative complication and earlier recovery.