ⅡA2期子宫颈癌腹腔镜与开腹手术长期肿瘤学结局的真实世界研究

Long-term oncological outcomes of laparoscopic versus abdominal approach to FIGO Stage Ⅱ A2 cervical cancer in real world study

目的在真实世界研究条件下分析接受腹腔镜或开腹手术的ⅡA2期子宫颈癌长期肿瘤学结局。方法基于中国子宫颈癌临床诊疗大数据库,筛选接受腹腔镜和开腹手术的ⅡA2期子宫颈癌患者,采用真实世界研究及倾向评分匹配的方法,通过K-M生存分析和Cox多因素分析对两组的长期肿瘤学结局进行比较。结果(1)初步筛选纳入ⅡA2期子宫颈癌1575例,腹腔镜组394例,开腹组1181例。匹配前,腹腔镜组与开腹组的5年总生存率(OS)和5年无瘤生存率(DFS)差异均无统计学意义(OS:75.48%vs.83.33%,P=0.505;DFS:78.02%vs.78.76%,P=0.578);Cox分析显示腹腔镜手术并非患者死亡或者复发/死亡的独立危险因素(P>0.050)。1∶2 PSM匹配后腹腔镜组和开腹组分别纳入389例和744例,腹腔镜组与开腹组的5年OS和5年DFS差异均无统计学意义(OS:75.62%vs.83.79%,P=0.612;DFS:78.52%vs.79.25%,P=0.772);Cox分析显示腹腔镜手术并非患者死亡或者复发/死亡的独立危险因素(P>0.050)。(2)进一步限制纳入手术类型为QM-B型或QM-C型子宫切除的病例后,腹腔镜组379例,开腹组1067例。匹配前腹腔镜组与开腹组的5年OS和5年DFS差异均无统计学意义(OS:77.11%vs.84.53%,P=0.573;DFS:79.02%vs.79.81%,P=0.585),Cox分析显示腹腔镜手术并非患者死亡或者复发/死亡的独立危险因素(P>0.050)。1∶2 PSM匹配后腹腔镜组和开腹组分别纳入371例和713例,腹腔镜组与开腹组的5年OS和5年DFS差异均无统计学意义(OS:77.27%vs.86.00%,P=0.382;DFS:79.48%vs.81.89%,P=0.365);Cox分析显示腹腔镜手术并非子宫颈癌患者死亡以及复发/死亡的独立危险因素(P>0.050)。结论从手术途径方面进行多层次对比分析显示,ⅡA2期子宫颈癌患者腹腔镜组与开腹组的长期肿瘤学结局无差异。

Objective To compare the long-term oncological outcomes of laparoscopic(LRH)and abdominal radical hysterectomy(ARH)for stageⅡA2 cervical cancer in real world study.Methods We retrospectively analyzed the data from big database of clinical diagnosis and treatment for cervical cancer in China,propensity score matching(PSM),K-M survival analysis and Cox multivariate analysis were used to compared the oncological outcomes between LRH and ARH.Results(1)A total of 1575 patients with stageⅡA2 cervical cancer treated by LRH(n=394)or ARH(n=1181)were included.Before matching,no significance was found between the two groups in 5-year OS or 5-year DFS(OS:75.48%vs.83.33%,P=0.505;DFS:78.02%vs.78.76%,P=0.578);Cox multivariate analysis showed that LRH was not the independent risk factor for death or relapse/death of the patients(P>0.050).After 1:2 PSM matching,there was no difference between LRH(n=389)and ARH(n=744)in OS or DFS(OS:75.62%vs.83.79%,P=0.612;DFS:78.52%vs.79.25%,P=0.772).Cox analysis showed that laparoscopic surgery was not the independent risk factor for death or relapse/death of the patients(P>0.050).(2)A total of 1446 patients who underwent hysterectomy in QM-B or QM-C were included.There was no difference between LRH(n=379)and ARH(n=1067)in OS and DFS(OS:77.11%vs.84.53%,P=0.573;DFS:79.02%vs.79.81%,P=0.585)before matching;Cox multivariate analysis showed that laparoscopic approach"was not the independent risk factor for death or relapse/death of the patients(P>0.050).After1:2 PSM matching,there was no difference between LRH(n=371)and ARH(n=713)in OS or DFS(OS:77.27%vs.86.00%,P-0.382;DFS:79.48%vs.81.89%,P=0.365).Cox multivariate analysis indicated that laparoscopic surgery was not an independent factor for death and relapse/death of the patients(P>0.050).Conclusion In the real world conditions based on the comparison and analysis of the surgical approaches in many aspects,it is shown that there is no difference between LRH and ARH in the oncological outcomes for stageⅡA2 cervical cancer.