全系膜切除术 (TMMR) 或根据FIGO (2009) IB1-IIB 期宫颈癌国际指南进行治疗后的肿瘤学结果:一项观察性队列研究。
Oncologic outcomes after Total Mesometrial Resection (TMMR) or treatment according to current international guidelines in FIGO (2009) stages IB1-IIB cervical cancer: an observational cohort study.
发表日期:2024 Jul
作者:
Henrik Falconer, Anna Norberg-Hardie, Sahar Salehi, Emilia Alfonzo, Laura Weydandt, Nadja Dornhöfer, Benjamin Wolf, Michael Höckel, Bahriye Aktas
来源:
ECLINICALMEDICINE
摘要:
根据国际指南,宫颈癌(CC)的治愈性标准治疗(ST)包括早期根治性子宫切除术和盆腔淋巴结清扫术(国际妇产科联合会(FIGO)2009 IB1、IIA1),建议根据情况进行辅助放化疗。最终病理学的危险因素。建议在局部晚期进行根治性放化疗(FIGO 2009 IB2、IIA2、IIB)。全系膜切除术(TMMR)联合治疗性淋巴结清扫术(tLND)而不进行辅助放射已成为一种有前景的治疗方法。在这里,我们通过 TMMR tLND 或 ST 比较肿瘤结果。在这项观察性队列研究中,在瑞典的基于人群的登记处确定了根据国际指南治疗的女性,在莱比锡系膜切除术 (MMR) 研究数据库中确定了接受 TMMR 治疗的女性(DRKS 0001517)2011-2020。提取相关临床和肿瘤相关变量。通过 ST 或 TMMR 分析无复发生存期 (RFS) 和总生存期 (OS),使用对数秩检验、累积发生函数和比例风险回归进行分析,得出具有 95% 置信区间 (CI) 的风险比 (HR),并针对相关因素进行调整2011年至2020年间,最终分析纳入了1007名女性。 733 名女性接受了 ST 治疗,274 名女性接受了 TMMR 治疗。 ST 和 TMMR 队列的五年 RFS 分别为 77.9% (95% CI 74.3-81.1) 和 82.6% (95% CI 77.2-86.9) (p = 0.053)。在早期 CC 中,TMMR 后的 RFS 高于 ST,分别为 91.2% 和 81.8% (p = 0.002)。在调整后的分析中,与 ST 相比,TMMR 的复发风险(HR 0.39;95% CI 0.22-0.69)和死亡风险(HR 0.42;95% CI 0.21-0.86)较低。 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 CC 中,未观察到 RFS 或 OS 存在显着差异。与 ST 相比,不进行放射治疗的 TMMR 与早期宫颈癌女性的良好肿瘤学结局相关,而在局部晚期宫颈癌中未观察到差异。我们的研究结果与之前的证据一起表明,TMMR 可能被认为是局限于苗勒管室的早期和局部晚期宫颈癌的主要选择。这项研究得到了南兰临床研究中心(瑞典)和斯德哥尔摩地区的资助(瑞典)。© 2024 作者。
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).© 2024 The Author(s).