目的:比较早期宫颈癌的原发性根治性手术和原发性放疗的生存结果。
方法:从监测中提取患者信息,流行病学,和结果数据库。诊断为T1a期早期宫颈癌的患者,T1b,和T2a(美国癌症联合委员会,第7版)从1998年到2015年被纳入本研究,经过倾向评分匹配。使用Kaplan-Meier方法分析总生存期(OS)。
结果:在纳入研究的4964名患者中,1080名患者被确定为淋巴结阳性(N1),3884例患者被确定为淋巴结阴性(N0)。N1组(P<0.001)和N0组(P<0.001)中,初次手术患者的5年OS明显长于初次放疗患者。在亚组分析中,在T1a期淋巴结阳性的患者中发现了类似的结果(100.0%vs.61.1%),T1b(84.1%与64.3%),和T2a(74.4%与63.8%)。在T1b1和T2a1患者中,初次手术比初次放疗导致更长的OS,但在T1b2和T2a2患者中没有。在多变量分析中,主要治疗被确定为N1和N0患者的独立预后因素(HRN1=2.522,95%CI=1.919-3.054,PN1<0.001;HRN0=1.895,95%CI=1.689-2.126,PN0<0.001).
结论:在早期宫颈癌T1a期,T1b1和T2a1,对于有和没有淋巴结转移的患者,初次手术可能比初次放疗导致更长的OS。
OBJECTIVE: To compare survival outcomes between primary radical surgery and primary radiation in early cervical cancer.
METHODS: Patient information was extracted from the Surveillance, Epidemiology, and Results database. Patients diagnosed with early cervical cancer of stage T1a, T1b, and T2a (American Joint Committee on Cancer, 7th edition) from 1998 to 2015 were included in this study after propensity score matching. Overall survival (OS) was analyzed using the Kaplan-Meier method.
RESULTS: Among the 4964 patients included in the study, 1080 patients were identified as having positive lymph nodes (N1), and 3884 patients were identified as having negative lymph nodes (N0). Patients with primary surgery had significantly longer 5-year OS than those with primary radiotherapy in both the N1 group (P<0.001) and N0 group (P<0.001). In the subgroup analysis, similar results were found in patients with positive lymph nodes of stage T1a (100.0% vs. 61.1%), T1b (84.1% vs. 64.3%), and T2a (74.4% vs. 63.8%). In patients with T1b1 and T2a1, primary surgery resulted in longer OS than primary radiation, but not in patients with T1b2 and T2a2. In multivariate analysis, the primary treatment was identified as an independent prognostic factor in both N1 and N0 patients (HRN1=2.522, 95% CI=1.919-3.054, PN1<0.001; HRN0=1.895, 95% CI=1.689-2.126, PN0<0.001).
CONCLUSIONS: In early cervical cancer stage T1a, T1b1, and T2a1, primary surgery may result in longer OS than primary radiation for patients with and without lymph node metastasis.