总介质切除术（TMMR）或根据FIGO（2009）阶段IB1-IIB宫颈癌的当前国际准则治疗后的肿瘤学结果：一项观察性队列研究

根据国际指南，在早期阶段，具有根治性子宫切除术和骨盆淋巴结切除术（国际妇科和产科联合会（FIGO）2009 IB1，IIA1，IIA1），辅助化学疗法对风险因素推荐了基于风险因素。建议在本地高级阶段进行确定的化学放疗（Figo 2009 IB2，IIA2，IIB）。没有辅助辐射的治疗性淋巴结清除（TLND）的全介质切除（TMMR）已成为一种有希望的治疗方法。在这里，我们比较了TMMR+TLND或St.In的肿瘤学结果，这项观察性队列研究是根据国际准则治疗的妇女在瑞典的基于人群的注册表中鉴定出来的妇女和用TMMR治疗的妇女在莱普齐格中性术中鉴定出了TMMR治疗的妇女。提取相关的临床和肿瘤相关变量。通过对数等级测试，累积的发生率函数和比例危险回归产生危害比率（HR），对相关困难进行了调整，并在最终分析中包含了95％置信区间（CI），对95％置信区间（CI）进行了调整，并在最终分析中包括了95％置信区间（CI），对NOG-CRANK检验，累积发生率函数和成比例危害回归危害比率（HR）进行调整，通过对数等级测试，累积的发生率和比例危害回归比率（HR）分析，将无复发生存期（RFS）和总生存期（OS）分析。根据ST进行了733名妇女的治疗，用TMMR治疗274名妇女。五年的RFS分别为77.9％（95％CI 74.3-81.1）和ST和TMMR队列分别为82.6％（95％CI 77.2-86.9）（p = 0.053）。在早期CC中，与ST相比，TMMR后RFS更高，91.2％vs 81.8％（p = 0.002）。在调整后的分析中，与ST相比，TMMR与较低的复发危害（HR 0.39; 95％CI 0.22-0.69）和死亡（HR 0.42; 95％CI 0.21-0.86）有关。 5年复发风险的绝对差异为9.4％（95％CI 3.2-15.7），有利于TMMR。在局部晚期的CC中，没有观察到RFS或OS的显着差异。我们的发现与以前的证据一起表明，TMMR可能被认为是局限于穆勒群岛的早期和局部宫颈癌的主要选择。这项研究得到了临床研究中心Sörmland中心（瑞典）和地区的斯德哥尔摩（瑞典）的赠款。

According to international guidelines, standard treatment (ST) with curative intent in cervical cancer (CC) comprises radical hysterectomy and pelvic lymphadenectomy in early stages (International Federation of Gynecology and Obstetrics (FIGO) 2009 IB1, IIA1), adjuvant chemoradiation is recommended based on risk factors upon final pathology. Definitive chemoradiation is recommended in locally advanced stages (FIGO 2009 IB2, IIA2, IIB). Total mesometrial resection (TMMR) with therapeutic lymph node dissection (tLND) without adjuvant radiation has emerged as a promising treatment. Here we compare oncologic outcome by TMMR + tLND or ST.In this observational cohort study, women treated according to international guidelines were identified in the population-based registries from Sweden and women treated with TMMR were identified in the Leipzig Mesometrial Resection (MMR) Study Database (DRKS 0001517) 2011-2020. Relevant clinical and tumour related variables were extracted. Recurrence-free survival (RFS) and overall survival (OS) by ST or TMMR was analysed with log-rank test, cumulative incidence function and proportional hazard regression yielding hazard ratios (HR) with 95% confidence intervals (CI), adjusted for relevant confounders.Between 2011 and 2020, 1007 women were included in the final analysis. 733 women were treated according to ST and 274 with TMMR. RFS at five years was 77.9% (95% CI 74.3-81.1) and 82.6% (95% CI 77.2-86.9) for the ST and TMMR cohorts respectively (p = 0.053). In early-stage CC, RFS was higher after TMMR as compared to ST, 91.2% vs 81.8% (p = 0.002). In the adjusted analysis, TMMR was associated with a lower hazard of recurrence (HR 0.39; 95% CI 0.22-0.69) and death (HR 0.42; 95% CI 0.21-0.86) compared to ST. The absolute difference in risk of recurrence at 5 years was 9.4% (95% CI 3.2-15.7) in favor of TMMR. In locally advanced CC, no significant differences in RFS or OS was observed.Compared to ST, TMMR without radiation therapy was associated with superior oncologic outcomes in women with early-stage cervical cancer whereas no difference was observed in locally advanced disease. Our findings together with previous evidence suggest that TMMR may be considered the primary option for both early-stage and locally advanced cervical cancer confined to the Müllerian compartment.This study was supported by grants from Centre for Clinical Research Sörmland (Sweden) and Region Stockholm (Sweden).