Tags

Type your tag names separated by a space and hit enter

Effect of the surgical approach on survival outcomes in patients undergoing radical hysterectomy for cervical cancer: A real-world multicenter study of a large Chinese cohort from 2006 to 2017.
Cancer Med. 2020 Jul 06 [Online ahead of print]CM

Abstract

OBJECTIVE

To compare survival outcomes of minimally invasive surgery (MIS) and laparotomy in early-stage cervical cancer (CC) patients.

METHODS

A multicenter retrospective cohort study was conducted with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage IA1 (lymphovascular invasion)-IIA1 CC patients undergoing MIS or laparotomy at four tertiary hospitals from 2006 to 2017. Propensity score matching and weighting and multivariate Cox regression analyses were performed. Survival was compared in various matched cohorts and subgroups.

RESULTS

Three thousand two hundred and fifty-two patients (2439 MIS and 813 laparotomy) were included after matching. (1) The 2- and 5-year recurrence-free survival (RFS) (2-year, hazard ratio [HR], 1.81;95% confidence interval [CI], 1.09-3.0; 5-year, HR, 2.17; 95% CI, 1.21-3.89) or overall survival (OS) (2-year, HR, 1.87; 95% CI, 1.03-3.40; 5-year, HR, 2.57; 95% CI, 1.29-5.10) were significantly worse for MIS in patients with stage I B1, but not the cohort overall (2-year RFS, HR, 1.04; 95% CI, 0.76-1.42; 2-year OS, HR, 0.99; 95% CI, 0.70-1.41; 5-year RFS, HR, 1.12; 95% CI, 0.76-1.65; 5-year OS, HR, 1.20; 95% CI, 0.79-1.83) or other stages (2) In a subgroup analysis, MIS exhibited poorer survival in many population subsets, even in patients with less risk factors, such as patients with squamous cell carcinoma, negative for parametrial involvement, with negative surgical margins, negative for lymph node metastasis, and deep stromal invasion < 2/3. (3) In the cohort treated with (2172, 54%) or without adjuvant treatment (1814, 46%), MIS showed worse RFS than laparotomy in patients treated without adjuvant treatment, whereas no differences in RFS and OS were observed in adjuvant-treatment cohort. (4) Inadequate surgeon proficiency strongly correlated with poor RFS and OS in patients receiving MIS compared with laparotomy.

CONCLUSIONS

MIS exhibited poorer survival outcomes than laparotomy group in many population subsets, even in low-risk subgroups. Therefore, laparotomy should be the recommended approach for CC patients.

Authors+Show Affiliations

Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32628356

Citation

Guo, Chenyan, et al. "Effect of the Surgical Approach On Survival Outcomes in Patients Undergoing Radical Hysterectomy for Cervical Cancer: a Real-world Multicenter Study of a Large Chinese Cohort From 2006 to 2017." Cancer Medicine, 2020.
Guo C, Tang X, Meng Y, et al. Effect of the surgical approach on survival outcomes in patients undergoing radical hysterectomy for cervical cancer: A real-world multicenter study of a large Chinese cohort from 2006 to 2017. Cancer Med. 2020.
Guo, C., Tang, X., Meng, Y., Zhang, Y., Zhang, X., Guo, J., Lei, X., Qiu, J., & Hua, K. (2020). Effect of the surgical approach on survival outcomes in patients undergoing radical hysterectomy for cervical cancer: A real-world multicenter study of a large Chinese cohort from 2006 to 2017. Cancer Medicine. https://doi.org/10.1002/cam4.3287
Guo C, et al. Effect of the Surgical Approach On Survival Outcomes in Patients Undergoing Radical Hysterectomy for Cervical Cancer: a Real-world Multicenter Study of a Large Chinese Cohort From 2006 to 2017. Cancer Med. 2020 Jul 6; PubMed PMID: 32628356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of the surgical approach on survival outcomes in patients undergoing radical hysterectomy for cervical cancer: A real-world multicenter study of a large Chinese cohort from 2006 to 2017. AU - Guo,Chenyan, AU - Tang,Xiaoyan, AU - Meng,Yan, AU - Zhang,Ying, AU - Zhang,Xuyin, AU - Guo,Jingjing, AU - Lei,Xiaohong, AU - Qiu,Junjun, AU - Hua,Keqin, Y1 - 2020/07/06/ PY - 2020/04/06/received PY - 2020/05/22/revised PY - 2020/06/20/accepted PY - 2020/7/7/entrez KW - cervical cancer KW - laparotomy KW - matching KW - minimally invasive surgery KW - radical hysterectomy KW - survival outcome JF - Cancer medicine JO - Cancer Med N2 - OBJECTIVE: To compare survival outcomes of minimally invasive surgery (MIS) and laparotomy in early-stage cervical cancer (CC) patients. METHODS: A multicenter retrospective cohort study was conducted with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage IA1 (lymphovascular invasion)-IIA1 CC patients undergoing MIS or laparotomy at four tertiary hospitals from 2006 to 2017. Propensity score matching and weighting and multivariate Cox regression analyses were performed. Survival was compared in various matched cohorts and subgroups. RESULTS: Three thousand two hundred and fifty-two patients (2439 MIS and 813 laparotomy) were included after matching. (1) The 2- and 5-year recurrence-free survival (RFS) (2-year, hazard ratio [HR], 1.81;95% confidence interval [CI], 1.09-3.0; 5-year, HR, 2.17; 95% CI, 1.21-3.89) or overall survival (OS) (2-year, HR, 1.87; 95% CI, 1.03-3.40; 5-year, HR, 2.57; 95% CI, 1.29-5.10) were significantly worse for MIS in patients with stage I B1, but not the cohort overall (2-year RFS, HR, 1.04; 95% CI, 0.76-1.42; 2-year OS, HR, 0.99; 95% CI, 0.70-1.41; 5-year RFS, HR, 1.12; 95% CI, 0.76-1.65; 5-year OS, HR, 1.20; 95% CI, 0.79-1.83) or other stages (2) In a subgroup analysis, MIS exhibited poorer survival in many population subsets, even in patients with less risk factors, such as patients with squamous cell carcinoma, negative for parametrial involvement, with negative surgical margins, negative for lymph node metastasis, and deep stromal invasion < 2/3. (3) In the cohort treated with (2172, 54%) or without adjuvant treatment (1814, 46%), MIS showed worse RFS than laparotomy in patients treated without adjuvant treatment, whereas no differences in RFS and OS were observed in adjuvant-treatment cohort. (4) Inadequate surgeon proficiency strongly correlated with poor RFS and OS in patients receiving MIS compared with laparotomy. CONCLUSIONS: MIS exhibited poorer survival outcomes than laparotomy group in many population subsets, even in low-risk subgroups. Therefore, laparotomy should be the recommended approach for CC patients. SN - 2045-7634 UR - https://www.unboundmedicine.com/medline/citation/32628356/Effect_of_the_surgical_approach_on_survival_outcomes_in_patients_undergoing_radical_hysterectomy_for_cervical_cancer:_A_real-world_multicenter_study_of_a_large_Chinese_cohort_from_2006_to_2017 L2 - https://doi.org/10.1002/cam4.3287 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.