| Objective: To explore the prognosis and pregnancy outcome in patients with early cervical cancer by radical trachelectomy(RT).Methods: This research is a retrospective cohort study.112young(<45y)patients with early(FIGO Ia1-Ib1)cervical cancer from January 1,2004 to December 30,2018 in Hunan Cancer Hospital were collected.26 patients were treated with vaginal radical trachelectomy in combination with pelvic lymphadenectomy(VRT),50 patients were treated with open radical trachelectomy in combination with pelvic lymphadenectomy(ART),36 patients were treated with laparoscopic radical trachelectomy in combination with pelvic lymphadenectomy(LRT).5 patients received 1-2 courses of neoadjuvant chemotherapy and9 patients received 2-6 courses of chemotherapy after surgery with an average of 4 courses among the 112 patients.The chemotherapy plan was BVP or TP.Follow-up data related to recurrence and pregnancy(including the time of recurrence,death,pregnancy,birth,premature delivery,abortion and postoperative pregnancy,etc.),Statistical analysisof the patients’ general clinical features,treatment methods,treatment effects and pregnancy outcomes.All data were statistically analyzed using SPSS 25.0 statistical software.Kaplan-Meier test method was used to draw a survival curve and recurrence free survival curve.Use the chi-square test and Fisher’s exact test to compare recurrence between groups,include statistically significant items in univariate analysis into the COX proportional hazard regression model for multivariate analysis,analyze multivariate analysis of patient recurrence,For the analysis of pregnancy outcome,chi-square test and Fisher’s exact test were used.If the comparison results between the two groups were statistically significant,the comparison between the two groups was conducted using Bonferroni correction method,P < 0.05 was statistically significant.Results: 1.The follow-up deadline was December 29,2019.Of the 112 patients with stage Ia1-Ib1 cervical cancer observed,9 relapsed and 2 died,with a recurrence rate of 8.04% and a mortality rate of 1.79%.The 2-year cumulative survival rate was 98%.The 5-year relapse-free survival rate was 95.4%.2.Results of univariate analysis: pathological type and tumor diameter are related to patient prognosis(P<0.05).age,reproductive history,clinical stage,cervical deep stromal infiltration,lymphatic vascular space infiltration,the surgical approach and whether adjuvant therapy before surgery are not related to the prognosis ofpatients(P>0.05).3.In multivariate analysis: Pathological type and Tumor diameter was an independent risk factor for recurrence in patients with early cervical cancer(P<0.05).4.Pregnancy outcome: 112 patients had 35 pregnancies,24 patients had births,14 patients had premature births,11 patients had abortions and 10 patients had full-term births.Total pregnancy rate was 31.25%(35/112),total fertility rate 21.43%(24/112),premature birth rate 40%(14/35),and miscarriage rate 31.43%(11/35).5.Effects of three surgical methods on pregnancy: 112 RT patients underwent extensive vaginal radical trachelectomy and laparoscopic pelvic lymph node dissection(VRT)in 26 cases,including 14 cases of pregnancy,with a pregnancy rate of 53.85%(14/26).Among the 112 RT patients,50 were treated with open radical trachelectomy and pelvic lymph node dissection(ART),of which 11 were pregnant,with a pregnancy rate of 22%(11/50).Among the 112 RT patients,laparoscopic radical trachelectomy and laparoscopic pelvic lymph node dissection(LRT)were performed in 36 patients,including 10 pregnancies,with a pregnancy rate of 27.78%(10/36).The pregnancy rate of VRT was higher than that of ART and LRT(P<0.05).6.Influence of neoadjuvant chemotherapy on pregnancy: according to preoperative neoadjuvant chemotherapy or not,it was divided into neoadjuvant chemotherapy group and direct surgery group.There was no statistically significantdifference in pregnancy rate between the two groups(P > 0.05).Conclusions: 1.Young patients with early cervical cancer who underwent radical trachelectomy had a low rate of recurrence and mortality,and a high survival rate.Radical trachelectomy is safe for young patients with early cervical cancer who wish to have children.In this retrospective study,the total pregnancy rate and total fertility rate of the patients were 31.25% and 21.43% respectively;2.Pathological type and tumor diameter are related to the prognosis and are the main risk factor affecting the prognosis of patients with early cervical cancer;3.The pregnancy rate of vaginal radical trachelectomy + laparoscopic pelvic lymphadenectomy(VRT)was higher than that of open radical trachelectomy + pelvic lymphadenectomy(ART)and laparoscopic radical trachelectomy + pelvic lymphadenectomy(LRT). |
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