【摘要】 目的从肿瘤学结局角度对比FIGO 2018子宫颈癌新分期ⅠB3期开腹广泛性子宫切除手术(ARH)、新辅助化疗后开腹手术(NACT)、根治性放化疗(R-CT)3种治疗方式的差异,探讨ⅠB3期子宫颈癌适宜治疗策略。方法基于中国子宫颈癌临床诊疗项目数据库,纳入FIGO 2018子宫颈癌ⅠB3期病例,在真实世界研究比较ARH组、NACT组及R-CT组的5年总体生存率(OS)及无病生存率(DFS)。结果 (1)从数据库中纳入FIGO 2018子宫颈癌ⅠB3期病例1434例,其中ARH组830例、NACT组484例、R-CT组120例。中位随访时间为46个月(ARH组55个月、NACT组44个月、R-CT组32个月)。(2)NACT组、ARH组及R-CT组之间5年OS差异有统计学意义(97.0%vs. 91.1%vs. 78.1%,P<0.001),5年DFS差异有统计学意义(92.3%vs. 87.4%vs. 71.1%,P<0.001)。(3)Cox回归分析提示NACT组发生死亡的风险是ARH组的0.352倍(HR=0.352,95%CI 0.189～0.654,P=0.001),不是复发/死亡的独立影响因素(HR=0.592,95%CI 0.391～0.898,P=0.202);R-CT组发生死亡的风险是ARH组的2.997倍(HR=2.997,95%CI 1.754～5.121,P<0.001),R-CT组发生复发/死亡的风险是ARH组的2.832倍(HR=2.832,95%CI 1.803～4.449,P<0.001)。结论比较3种治疗方式的肿瘤学结局,FIGO 2018子宫颈癌ⅠB3期接受新辅助化疗后开腹手术的肿瘤学结局最佳,接受开腹广泛性子宫切除手术次之,接受根治性放化疗较差。因此,ⅠB3期的合适治疗方式可能是新辅助化疗后手术。更多还原

【Abstract】 Objective Based on the perspective of oncological outcomes,the comparison was made among abdominal radical hysterectomy(ARH),neoadjuvant chemotherapy followed by surgery(NACT),and radical radio-chemotherapy(R-CT)to explore the appropriate treatment strategy for FIGO 2018 new stage ⅠB3 cervical cancer.Methods Based on the clinical diagnosis and treatment for cervical cancer in China,the patients with FIGO 2018 stage ⅠB3 cervical cancer were included,and the 5-year overall survival(OS)and disease-free survival(DFS)of ARH group,NACT group and R-CT group were compared in realworld study.Results (1)A total of 1434 patients with FIGO 2018 stage Ⅰ B3 cervical cancer were included,including 830 patients in the ARH group,484 patients in the NACT group,and 120 patients in the R-CT group.The median follow-up period was 46 months(55 months for ARH,44 months for NACT,and 32 months for R-CT).(2)The 5-year OS difference among the NACT group,ARH group and R-CT group was statistically significant(97.0% vs. 91.1% vs. 78.1%,P<0.001),and the 5-year DFS difference was statistically significant(92.3% vs.87.4% vs. 71.1%,P<0.001).(3)Multivariate analysis suggested that the NACT group had a 0.352 times higher risk of death than the ARH group(HR=0.352,95%CI 0.189-0.654,P=0.001),and was not an independent influencing factor for recurrence/death(HR=0.592,95%CI 0.391-0.898,P=0.202);the risk of death in the R-CT group was 2.997 times that in the ARH group(HR=2.997,95%CI 1.754-5.121,P<0.001),and the risk of recurrence/death was 2.832 times that in the ARH group(HR=2.832,95%CI 1.803-4.449,P<0.001).Conclusions Comparing the oncological outcomes of the three treatments,the oncological outcomes of NACT group are the best,the ARH group the second,and the R-CT group the worst. Therefore,the appropriate treatment for FIGO 2018 stage Ⅰ B3 cervical cancer may be neoadjuvant chemotherapy followed by surgery.更多还原