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Hazard Ratio Analysis of Laparoscopic Radical Hysterectomy for IA1 With LVSI-IIA2 Cervical Cancer: Identifying the Possible Contraindications of Laparoscopic Surgery for Cervical Cancer.
Front Oncol. 2020; 10:1002.FO

Abstract

Objectives:

This study aimed to compare the 5-year disease-free survival (DFS) and overall survival (OS) of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for IA1 with lymphovascular space invasion (LVSI)-IIA2 cervical cancer and to analyze the Cox proportional hazard ratio (HR) of LRH among the total study population and different subgroups.

Methods:

This was a multicenter retrospective cohort study. The oncological outcomes of LRH (n = 4,236) and ARH (n = 9,177) were compared. The HRs and 95% confidence intervals for the effect of LRH on 5-year OS and DFS were estimated by Cox proportional hazards models.

Results:

Overall, there was no difference in DFS between LRH and ARH in the unadjusted analysis (HR 1.11, 95% CI: 0.99-1.25, p = 0.075). The risk-adjusted analysis revealed that LRH was independently associated with inferior DFS (HR 1.25, 95% CI: 1.11-1.40, p < 0.001). There was no difference in OS between the two groups in the unadjusted analysis (HR 1.00, 95% CI: 0.85-1.17, p = 0.997) or risk-adjusted analysis (HR 1.15, 95% CI: 0.98-1.35, p = 0.091). For patients with FIGO stage IB1 and tumor size <2 cm, LRH was not associated with lower DFS or OS (p = 0.637 or p = 0.107, respectively) in risk-adjusted analysis. For patients with FIGO stage IB1 and tumor size ≥2 cm, LRH was associated with lower 5-year DFS (HR 1.42, 95% CI: 1.19-1.69, p < 0.001) in risk-adjusted analysis, but it was not associated with lower 5-year OS (p = 0.107). For patients with FIGO stage IIA1 and tumor size <2 cm, LRH was not associated with lower 5-year DFS or OS (p = 0.954 or p = 0.873, respectively) in risk-adjusted analysis. For patients with FIGO stage IIA1 and tumor size ≥2 cm, LRH was associated with lower DFS (HR 1.48, 95% CI: 1.16-1.90, p = 0.002) and 5-year OS (HR 1.69, 95% CI: 1.22-2.33, p = 0.002) in risk-adjusted analysis.

Conclusion:

The 5-year DFS of LRH was worse than that of ARH for FIGO stage IA1 with LVSI-IIA2. LRH is not an appropriate option for FIGO stage IB1 or IIA1 and tumor size ≥ 2 cm compared with ARH.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University, Chongqing, China.Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, China.Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China.Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32733796

Citation

Li, Pengfei, et al. "Hazard Ratio Analysis of Laparoscopic Radical Hysterectomy for IA1 With LVSI-IIA2 Cervical Cancer: Identifying the Possible Contraindications of Laparoscopic Surgery for Cervical Cancer." Frontiers in Oncology, vol. 10, 2020, p. 1002.
Li P, Liu P, Yang Y, et al. Hazard Ratio Analysis of Laparoscopic Radical Hysterectomy for IA1 With LVSI-IIA2 Cervical Cancer: Identifying the Possible Contraindications of Laparoscopic Surgery for Cervical Cancer. Front Oncol. 2020;10:1002.
Li, P., Liu, P., Yang, Y., Wang, L., Liu, J., Bin, X., Lang, J., & Chen, C. (2020). Hazard Ratio Analysis of Laparoscopic Radical Hysterectomy for IA1 With LVSI-IIA2 Cervical Cancer: Identifying the Possible Contraindications of Laparoscopic Surgery for Cervical Cancer. Frontiers in Oncology, 10, 1002. https://doi.org/10.3389/fonc.2020.01002
Li P, et al. Hazard Ratio Analysis of Laparoscopic Radical Hysterectomy for IA1 With LVSI-IIA2 Cervical Cancer: Identifying the Possible Contraindications of Laparoscopic Surgery for Cervical Cancer. Front Oncol. 2020;10:1002. PubMed PMID: 32733796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hazard Ratio Analysis of Laparoscopic Radical Hysterectomy for IA1 With LVSI-IIA2 Cervical Cancer: Identifying the Possible Contraindications of Laparoscopic Surgery for Cervical Cancer. AU - Li,Pengfei, AU - Liu,Ping, AU - Yang,Ying, AU - Wang,Lu, AU - Liu,Jiaqi, AU - Bin,Xiaonong, AU - Lang,Jinghe, AU - Chen,Chunlin, Y1 - 2020/07/08/ PY - 2019/09/16/received PY - 2020/05/20/accepted PY - 2020/8/1/entrez PY - 2020/8/1/pubmed PY - 2020/8/1/medline KW - cervical cancer KW - hazard ratio KW - laparoscopy KW - oncological outcomes KW - radical hysterectomy SP - 1002 EP - 1002 JF - Frontiers in oncology JO - Front Oncol VL - 10 N2 - Objectives: This study aimed to compare the 5-year disease-free survival (DFS) and overall survival (OS) of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for IA1 with lymphovascular space invasion (LVSI)-IIA2 cervical cancer and to analyze the Cox proportional hazard ratio (HR) of LRH among the total study population and different subgroups. Methods: This was a multicenter retrospective cohort study. The oncological outcomes of LRH (n = 4,236) and ARH (n = 9,177) were compared. The HRs and 95% confidence intervals for the effect of LRH on 5-year OS and DFS were estimated by Cox proportional hazards models. Results: Overall, there was no difference in DFS between LRH and ARH in the unadjusted analysis (HR 1.11, 95% CI: 0.99-1.25, p = 0.075). The risk-adjusted analysis revealed that LRH was independently associated with inferior DFS (HR 1.25, 95% CI: 1.11-1.40, p < 0.001). There was no difference in OS between the two groups in the unadjusted analysis (HR 1.00, 95% CI: 0.85-1.17, p = 0.997) or risk-adjusted analysis (HR 1.15, 95% CI: 0.98-1.35, p = 0.091). For patients with FIGO stage IB1 and tumor size <2 cm, LRH was not associated with lower DFS or OS (p = 0.637 or p = 0.107, respectively) in risk-adjusted analysis. For patients with FIGO stage IB1 and tumor size ≥2 cm, LRH was associated with lower 5-year DFS (HR 1.42, 95% CI: 1.19-1.69, p < 0.001) in risk-adjusted analysis, but it was not associated with lower 5-year OS (p = 0.107). For patients with FIGO stage IIA1 and tumor size <2 cm, LRH was not associated with lower 5-year DFS or OS (p = 0.954 or p = 0.873, respectively) in risk-adjusted analysis. For patients with FIGO stage IIA1 and tumor size ≥2 cm, LRH was associated with lower DFS (HR 1.48, 95% CI: 1.16-1.90, p = 0.002) and 5-year OS (HR 1.69, 95% CI: 1.22-2.33, p = 0.002) in risk-adjusted analysis. Conclusion: The 5-year DFS of LRH was worse than that of ARH for FIGO stage IA1 with LVSI-IIA2. LRH is not an appropriate option for FIGO stage IB1 or IIA1 and tumor size ≥ 2 cm compared with ARH. SN - 2234-943X UR - https://www.unboundmedicine.com/medline/citation/32733796/Hazard_Ratio_Analysis_of_Laparoscopic_Radical_Hysterectomy_for_IA1_With_LVSI_IIA2_Cervical_Cancer:_Identifying_the_Possible_Contraindications_of_Laparoscopic_Surgery_for_Cervical_Cancer_ DB - PRIME DP - Unbound Medicine ER -
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