| Background:Endometrial cancer is one of the common malignant tumors in women,which seriously endangers women’s life and health.In China,according to the data of the National Cancer Center,its incidence occupies the sixth place among the most common malignant tumors in women,and the incidence rate is increasing year by year and is gradually becoming younger.At present,the treatment confusion of FIGO stage Ⅱ endometrial cancer comes from the inability to determine whether the cervical stroma is involved before operation,and its diagnosis depends on the histopathological diagnosis after comprehensive staging surgery.In clinical practice,the selection of the scope of hysterectomy for stage Ⅱ endometrial cancer is still controversial.In the current internationally recognized guidelines,opinions on the scope of hysterectomy for patients with FIGO Ⅱ endometrial cancer are also different.Until now,there is no prospective study to compare the effect of the extent of hysterectomy on the prognosis of patients with stage Ⅱ endometrial carcinoma.Objective:We aim to compare the survival and perioperative outcomes of patients with stage Ⅱ endometrial carcinoma(EC)undergoing simple hysterectomy(SH)or radical hysterectomy(RH).Methods:A single,retrospective propensity score matching study was performed to identify patients with FIGO 2009 stage Ⅱ EC who underwent surgical staging between 2005 and 2016 at the Department of Gynecology,Qilu Hospital of Shandong University.Inclusion criteria were as follows:(1)the age of the patient is between 20 and 80 years old,(2)all types of histology,(3)no intraoperative and preoperative evidence of extrauterine spread,(4)performance of hysterectomy and bilateral salpingectomy at least,(5)histopathologically proven cervical stromal involvement.Exclusion criteria:(1)other than FIGO Ⅱ,(2)received other treatments(such as endocrine therapy,early chemotherapy,radiotherapy,etc.,)before operation,(3)combined with other system malignant tumors(such as breast cancer,thyroid cancer,etc.),(4)incomplete follow-up information.Patient’ s demographic,surgical,pathological,and postoperative variables in the two groups were analyzed and compared using X2-tests before and after matching.P<0.05 was considered to indicate statistical significance.Survival was compared using the Kaplan-Meier analysis and log-rank test,the 3-year and 5-year overall survival rate(OS)and disease-free survival rate(DFS)were calculated.Results:A total of 89 patients with a mean age of 54.28±10.56 years were analyzed.The median follow-up in the cohort was 64(range 1-166)months.In these women,35(39.3%)underwent radical hysterectomy,and 54(60.7%)underwent simple hysterectomy.RH was associated with more intraoperative bleeding(mean_standard deviation:438.71±368.72 mL vs 209.57± 124.13mL,respectively,P<0.001)and higher perioperative blood transfusion rate(41.9%vs 2.2%,P<0.001).In addition,the longer surgical time(167.26±37.17 minutes vs 128.41 ±42.79 minutes,P=0.119)and longer length of hospital stay after surgery(13.16±4.80 days vs 10.65 ± 3.67 days,P=0.388)in the radical hysterectomy group.There were significant differences in the age,menopause,combined hypertension,lymph node dissection range,and surgical approach between the two groups of patients before the propensity score matching(P<0.05),and there were no statistical differences in other factors(P>0.05).After propensity score matching,we found that women who underwent simple hysterectomy were similar to those who underwent radical hysterectomy in terms of demographic,surgical and pathological variables.The 3-year overall survival(OS)in the simple hysterectomy and radical hysterectomy groups before matching were 92.6%and 97.1%,and the 5-year OS were 84.1%and 93.5%(P=0.094)),respectively.The 3-year disease-free survival(DFS)in the simple hysterectomy and radical hysterectomy groups before matching were 92.6%and 94.3%,and the 5-year DFS were 84.1%and 91.4%(P=0.186),respectively.After matching,the 3-year OS in the simple hysterectomy and radical hysterectomy groups were 95.2%and 97.1%,and the 5-year OS were 74%and 93.5%(P=0.002),respectively.The 3-year DFS in the simple hysterectomy and radical hysterectomy groups were 95.2%and 94.3%,and the 5-year DFS were 74%and 91.4%(P=0.009),respectively.Conclusions:1.For patients with stage FIGO II endometrial carcinoma who underwent surgical and pathological staging,patients who underwent radical hysterectomy had longer operation time,more blood loss and higher perioperative blood transfusion rate.2.For patients with stage FIGO II endometrial cancer who underwent surgical and pathological staging,the prognosis of patients with radical hysterectomy was better than that of simple hysterectomy.Patients with suspected cervical involvement before operation were recommended to undergo radical hysterectomy. |
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