[Long-term oncological outcomes of laparoscopic versus abdominal surgery in stage â
a1 ï¼LVSI+ï¼-â
b1 cervical cancer patients with different tumor size: a big database in China].
Zhonghua Fu Chan Ke Za Zhi
; 55(9): 589-599, 2020 Sep 25.
Article
em Zh
| MEDLINE
| ID: mdl-32957747
Objective: To compare the long-term oncological outcomes between laparoscopic and abdominal surgery in stage â
a1 ï¼lymph-vascular space invasion-positive, LVSI+ï¼- â
b1 cervical cancer patients with different tumor sizes. Methods: Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China (1538 project database), patients with stage â
a1 ï¼LVSI+ï¼-â
b1 cervical cancer who treated by laparoscopic or abdominal surgery were included. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) between the two surgical approaches were compared under 1â¶1 propensity score matching (PSM) in different tumor diameter stratification. Results: (1) A total of 4 891 patients with stage â
a1 ï¼LVSI+ï¼-â
b1 cervical cancer who underwent laparoscopy or laparotomy from January 1, 2009 to December 31, 2016 were included in the 1538 project database. Among them, 1 926 cases in the laparoscopic group and 2 965 cases in the abdominal group. There were no difference in 5-year OS and 5-year DFS between the two groups before matching. Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.367, 95%CI: 1.105-1.690, P=0.004). After 1â¶1 PSM matching, 1 864 patients were included in each group, and there was no difference in 5-year OS between the two groups ï¼94.1% vs 95.4%, P=0.151ï¼. While, the inferior 5-year DFS was observed in the laparoscopic group (89.0% vs 92.3%, P=0.004). And the laparoscopic surgery was associated with lower 5-year DFS (HR=1.420, 95%CI: 1.109-1.818, P=0.006). (2) In stratification analysis of different tumor sizes, and there were no difference in 5-year OS and 5-year DFS between the laparoscopic group and abdominal group in tumor size ≤1 cm, >1-2 cm and >2-3 cm stratification (all P>0.05). Cox multivariate analysis showed that laparoscopic surgery were not related to 5-year OS and 5-year DFS (P>0.05). In the stratification of tumor size >3-4 cm, there was no difference in 5-year OS between the two groups (P>0.05). The 5-year DFS in the laparoscopic group was worse than that in the abdominal group (75.7% vs 85.8%, P=0.025). Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.705, 95%CI: 1.088-2.674, P=0.020). Conclusions: For patients with stage â
a1 ï¼LVSI+ï¼-â
b1 cervical cancer, laparoscopic surgery is associated with lower 5-year DFS, and the adverse effect of laparoscopic surgery on oncology prognosis is mainly reflected in patients with tumor size >3-4 cm. For patients with tumor sizes ≤1 cm, >1-2 cm and >2-3 cm, there are no difference in oncological prognosis between the two surgical approaches.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Neoplasias do Colo do Útero
/
Laparoscopia
/
Laparotomia
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
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Female
/
Humans
/
Middle aged
País/Região como assunto:
Asia
Idioma:
Zh
Revista:
Zhonghua Fu Chan Ke Za Zhi
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
China