腹腔镜手术与开腹手术后I期上皮性卵巢癌患者复发与生存的比较：一项倾向匹配队列的回顾性分析
Comparison of Recurrence and Survival Between Patients With Pathological Stage I Epithelial Ovarian Cancer After Laparoscopic or Laparotomic Surgery: Retrospective Analysis of a Propensity-Matched Cohort
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影响因子:3.3
分区:医学2区 / 妇产科学2区
发表日期:2024 Nov
作者:
Si-Yu Cao, Yu Fan, Cheng-Yu Zhao, Yu-Fei Zhang, Yi Mu, Jin-Ke Li
DOI:
10.1016/j.jmig.2024.07.005
摘要
旨在比较腹腔镜或开腹手术治疗FIGO I期上皮性卵巢癌的肿瘤学结局。回顾性队列研究。三级医院妇科肿瘤科。研究对象为2013年1月1日至2019年12月31日间在四川大学华西第二医院（中国成都）接受腹腔镜分期手术的85例和接受开腹分期手术的206例FIGO I期上皮性卵巢癌患者。手术类型为腹腔镜或开腹分期手术。在倾向评分匹配之前，开腹组显示术前血清CA125升高的发生率较高（48.5%比35.3%，p = 0.045）以及肿瘤最大直径>15cm（27.2%比5.9%，p < 0.001）。多变量分析显示，较高的体质量指数（BMI）与更好的总生存期相关（调整风险比HR 0.83，95%置信区间CI 0.70-0.99，p = 0.043）。在根据年龄、BMI、CA125水平、最大肿瘤直径、FIGO分期、既往腹部手术史和美国麻醉医师协会分级的倾向评分匹配后（每组82例），5年无进展生存率在腹腔镜组（87.1%，95% CI 79.3-95.7%）与开腹组（90.9%，95% CI 84.7-97.6%）之间无显著差异（p = 0.524），5年总生存率也相似（93.9%，95% CI 88.0-100.0%比94.7%，95% CI 89.8-99.9%，p = 0.900）。无论是否匹配，两组在随访中（中位54.9个月）复发率均为9-11%。结论显示，腹腔镜和开腹手术治疗I期上皮性卵巢癌的复发率和生存率可能相似。由于腹腔镜手术出血少、恢复快，且安全有效，可能成为适合患者的开腹手术的替代方案。
Abstract
To compare oncologic outcomes after laparoscopic or laparotomic surgery to treat epithelial ovarian carcinoma in FIGO Stage I.Retrospective cohort study.Gynecological cancer ward in a tertiary hospital.A total of 85 patients with FIGO Stage I epithelial ovarian carcinoma who underwent laparoscopic staging surgery and 206 who underwent laparotomic staging surgery at West China Second Hospital, Sichuan University (Chengdu, China) between January 1, 2013 and December 31, 2019.Laparoscopic surgery or laparotomic staging surgery.Before propensity score-based matching, the laparotomy group showed higher prevalence of preoperative elevated CA125 level (48.5% vs 35.3%, p = .045) and tumors >15 cm (27.2% vs 5.9%, p <.001). Multivariate analysis associated higher body mass index with better overall survival (adjusted HR 0.83, 95% CI 0.70-0.99, p = .043). Among propensity score-matched patients (82 per group) who were matched to each other according to propensity scoring based on age, body mass index, CA125 level, largest tumor diameter, FIGO stage, history of abdominal surgery, and American Society of Anesthesiologists grade, the rate of progression-free survival at 5 years was similar between the laparoscopy group (87.1%, 95% CI 79.3-95.7%) and the laparotomy group (90.9%, 95% CI 84.7-97.6%, p = .524), as was the rate of overall survival at 5 years (93.9%, 95% CI 88.0-100.0% vs 94.7%, 95% CI 89.8-99.9%, p = .900). Regardless of whether patients were matched, the two groups showed similar rates of recurrence of 9-11% during follow-up lasting a median of 54.9 months.Rates of recurrence and survival may be similar between laparoscopy or laparotomy to treat Stage I epithelial ovarian cancer. Since laparoscopy is associated with less bleeding and faster recovery, it may be a safe, effective alternative to laparotomy for appropriate patients.