广泛性或改良广泛性子宫切除术与筋膜外子宫切除术对Ⅱ期子宫内膜癌患者预后的影响

Prognosis analysis of radical or modified radical hysterectomy and simple hysterectomy in patients with stageⅡendometrial cancer

目的比较行子宫广泛性切除术(RH)或改良子宫广泛性切除术(mRH)与筋膜外子宫切除术(SH)的Ⅱ期子宫内膜癌(EC)患者预后的差异,并分析影响Ⅱ期EC患者预后的相关因素。方法选取2006年1月—2021年1月于北京大学人民医院接受分期手术且术后病理检查证实为国际妇产科联盟2009年(FIGO 2009)分期Ⅱ期的47例EC患者的临床病理资料进行回顾性分析,患者的年龄为(54.4±10.7)岁,中位随访时间为65个月(9~138个月)。根据手术范围的不同分为RH或mRH(RH/mRH)组(14例)、SH组(33例),比较两组患者预后的差异,同时探究影响Ⅱ期EC患者预后的相关因素。结果(1)RH/mRH组、SH组患者合并高血压的比例分别为2/14、45%(15/33),术中出血量分别为(702±392)、(438±298)ml,术后并发症发生率分别为7/14、15%(5/33),上述指标两组间分别比较,差异均有统计学意义(P均<0.05)。(2)RH/mRH组与SH组患者的中位随访时间分别为72、62个月,两组比较,差异无统计学意义(P=0.515)。Kaplan-Meier法绘制生存曲线并经log-rank检验显示,RH/mRH组、SH组患者的5年无进展生存(PFS)率分别为94.3%、84.0%,5年总生存率分别为94.3%、92.9%,两组分别比较,差异均无统计学意义(P=0.501,P=0.957)。单因素分析显示,年龄、术前血清癌抗原125(CA125)水平、病理类型、雌激素受体(ER)表达状态均显著影响Ⅱ期EC患者的5年PFS率(P均<0.05),而手术方式(RH/mRH与SH)并不影响Ⅱ期EC患者的5年PFS率(P=0.508);多因素分析显示,术前血清CA125水平和ER表达状态均为显著影响Ⅱ期EC患者5年PFS率的独立因素(P均<0.05)。结论与SH比较,RH或mRH并未为Ⅱ期EC患者带来生存获益,反而增加了术中出血量及术后并发症发生率,需要重新考虑在Ⅱ期EC患者中扩大手术范围的必要性。

Objective To compare the prognosis and perioperative situation of patients with stageⅡendometrial cancer(EC)between radical hysterectomy/modified radical hysterectomy(RH/mRH)and simple hysterectomy(SH).Methods A total of 47 patients diagnosed EC with stageⅡ[International Federation of Gynecology and Obstetrics(FIGO)2009]by postoperative pathology,from January 2006 to January 2021 in Peking University People′s Hospital,were analyzed retrospectively.The patients were(54.4±10.7)years old,and the median follow-up time was 65 months(ranged 9-138 months).They were divided into RH/mRH group(n=14)and SH group(n=33)according to the scope of operation.Then the prognosis of patients between the groups were compared,and the independent prognostic factors of stageⅡEC were explored.Results(1)The proportions of patients with hypertension in RH/mRH group and SH group were 2/14 and 45%(15/33),the amounts of intraoperative blood loss were(702±392)and(438±298)ml,and the incidence of postoperative complications were 7/14 and 15%(5/33),respectively.There were significant differences(all P<0.05).(2)The median follow-up time of RH/mRH group and SH group were 72 vs 62 months,respectively(P=0.515).According to Kaplan-Meier analysis and log-rank method,the results showed that there were no significant difference in 5-year progression-free survival(PFS)rate(94.3%vs 84.0%;P=0.501),and 5-year overall survival rate(92.3%vs 92.9%;P=0.957)between the two groups.Cox survival analysis indicated that age,pathological type,serum cancer antigen 125(CA125),and estrogen receptor(ER)status were associated with 5-year PFS rate(all P<0.05).But the scope of hysterectomy(RH/mRH and SH)did not affect the 5-year PFS rate of stageⅡEC patients(P=0.508).And level of serum CA125 and ER status were independent prognostic factors for 5-year PFS rate(all P<0.05).Conclusions This study could not find any survival benefit from RH/mRH for stageⅡEC,but increases the incidence of postoperative complications.Therefore,the necessity of extending the scope of hysterectomy is questionable.