摘要
目的应用大数据探讨中国ⅠB2期子宫颈癌患者腹腔镜与开腹手术的长期肿瘤学结局差异。方法基于中国子宫颈癌临床诊疗大数据库,回顾性分析2009—2016年国内部分地区ⅠB2期子宫颈癌腹腔镜与开腹手术病例,通过真实世界研究(RWS)和倾向评分匹配(PSM)的方法,分析2种手术途径5年总体生存率(OS)和无病生存率(DFS)的差异。结果(1)初始入组共纳入2176例病例,其中腹腔镜组646例,开腹组1530例。匹配前两组5年OS差异无统计学意义(82.5%vs.88.4%,P=0.060),但5年DFS腹腔镜组低于开腹组(77.6%vs.83.9%,P=0.001),Cox比例风险模型分析显示腹腔镜手术是患者5年死亡和复发/死亡的独立危险因素(OS:HR=1.398,95%CI 1.029~1.898,P=0.032;DFS:HR=1.540,95%CI 1.220~1.943,P<0.001)。1∶2 PSM匹配后共纳入1575例病例,其中腹腔镜组525例,开腹组1050例;腹腔镜组的5年OS和DFS均低于开腹组(OS:82.4%vs.89.2%,P=0.042;DFS:77.6%vs.85.0%,P=0.001),Cox比例风险模型分析显示腹腔镜手术是患者5年死亡和复发/死亡的独立危险因素(OS:HR=1.457,95%CI 1.022~2.077,P=0.037;DFS:HR=1.569,95%CI 1.198~2.054,P=0.001)。(2)进一步限定手术类型为QM-B型或QM-C型子宫切除为纳入条件,共入组2066例病例,其中腹腔镜组627例,开腹组1439例;匹配前两组的5年OS差异无统计学意义(82.1%vs.88.2%,P=0.056),但5年DFS腹腔镜组低于开腹组(77.5%vs.83.6%,P=0.001),Cox比例风险模型分析显示腹腔镜手术是患者5年死亡和复发/死亡的独立危险因素(OS:HR=1.421,95%CI 1.044~1.935,P=0.025;DFS:HR=1.529,95%CI 1.207~1.938,P<0.001)。1∶2 PSM匹配后共纳入1470例病例,其中腹腔镜组490例,开腹组980例;两组的5年OS差异无统计学意义(83.2%vs.88.8%,P=0.126),但5年DFS腹腔镜组低于开腹组(77.5%vs.84.7%,P=0.001),Cox比例风险模型显示腹腔镜手术仅是患者5年复发/死亡的独立危险因素(HR=1.575,95%CI 1.191~2.081,P=0.001)。结论ⅠB2期子宫颈癌患者腹腔镜手术与开腹手术相比,接受腹腔镜手术的患者具有更低的DFS,腹腔镜手术是该期患者复发/死亡的独立危险因素。
Objective To compare the long-term oncological outcomes between laparoscopic(LRH) and abdominal(ARH) surgery in Chinese patients with stage I B2 cervical cancer based on big data.Methods Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China,we analyzed the LRH and ARH cases of stage I B2 cervical cancer from 2009 to 2016 in China retrospectively.Differences in 5-year overall survival(OS)and 5-year disease-free survival(DFS) between two surgical approaches were analyzed by real world study(RWS) and propensity score matching(PSM).Results(1) A total of 2176 patients were enrolled in initial analysis,including 646 patients in LRH group and 1530 patients in ARH group.Before matching,there was no difference in 5-year OS between two groups(82.5% vs.88.4%,P=0.060),but LRH had lower 5-year DFS(77.6% vs.83.9%,P=0.001).Cox proportional hazard model analysis suggested LRH was an independent risk factor for death and recurrence/death(OS:HR=1.398,95%CI1.029-1.898,P=0.032;DFS:HR=1.540,95%CI 1.220-1.943,P<0.001).After 1:2 ratio matching,1575 patients were included,with 525 patients in LRH group and 1050 patients in ARH group.The 5-year OS and DFS in LRH were both lower than those of ARH(OS:82.4% vs.89.2%,P=0.042;DFS:77.6% vs.85.0%,P=0.001).Cox proportional hazard model analysis showed LRH was an independent risk factor for death and recurrence/death(OS:HR=1.457,95% CI1.022-2.077,P=0.037;:DFS:HR=1.569,95 % CI 1.198-2.054,P=0.001).(2) A total of 2066 patients with QM-B or QM-C hysterectomy were further enrolled,including 627 patients in LRH group and 1439 patients in ARH group.Before matching,there was no difference in 5-year OS between two group(82.1 % vs.88.2%,P=0.056),but 5-year DFS in LRH was lower(77.5% vs.83.6%,P=0.001).Cox proportional hazard model analysis suggested LRH was an independent risk factor for death and recurrence/death(OS:HR=1.421,95%CI 1.044-1.935,P=0.025;DFS:HR=1.529,95%CI 1.201-1.938,P<0.001).After 1:2 ratio matching,1470 patients were included,with 490 patients in LRH group and 980 patients in ARH group.There was no difference in 5-year OS between two groups(83.2% vs.88.8%,P=0.126),but 5-year DFS in LRH was lower(77.5% vs.84.7%,P=0.001).Cox proportional hazard model analysis showed LRH was an independent risk factor only for recurrence or death(HR=1.575,95% Cl 1.191-2.081,P=0.001).Conclusion Laparoscopic radical hysterectomy is associated with lower disease-free survival than abdominal radical hysterectomy,and laparoscopic surgery is an independent risk factor for recurrence/death in patients with stage Ⅰ B2 cervical cancer.
作者
陈春林
倪妍
陈嘉铭
段慧
王倩青
王绍光
戴恩成
郝敏
王中海
凌斌
唐连
姜文轩
宾晓农
郎景和
刘萍
CHEN Chun-lin;NI Yan;CHEN Jia-ming;DUAN Hui;WANG Qian-qing;WANG Shao-guang;DAI En-cheng;HAO Min;WANG Zhong-hai;LING Bin;TANG Lian;JIANG Wen-xuan;BIN Xiao-nong;LANG Jing-he;LIU Ping(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;不详)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2020年第10期982-989,共8页
Chinese Journal of Practical Gynecology and Obstetrics
基金
十二五国家科技支撑计划(2014BAI05B03)
国家自然科学基金(81272585)
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)。
关键词
子宫颈肿瘤
腹腔镜手术
开腹手术
肿瘤学结局
真实世界研究
cervical neoplasms
laparoscopic surgery
abdominal surgery
oncological outcomes
real world study
作者简介
共同第一作者:陈春林,倪妍,陈嘉铭;共同通讯作者:刘萍,电子信箱:lpivy@126.com;共同通讯作者:陈春林,电子信箱:ccl1@smu.edu.cn。
