| Part1: Recurrence,metastasis and survival outcomes after laparoscopic radical hysterectomy of stage IA1-IIA2 cervical cancerObjective: To explore the clinicopathological factors of recurrence,metastasis and survival outcome of stage IA1-IIA2(FIGO 2009)cervical cancer(CC)after laparoscopic radical hysterectomy(LRH),and to analyze the effect of different colpotomy paths on recurrence,metastasis and sites of recurrence.Methods: The medical records of patients with stage IA1-IIA2 cervical cancer who underwent laparoscopic radical hysterectomy for cervical cancer in the First Affiliated Hospital of Army Medical University from 2015 to 2018 were retrospectively analyzed.COX univariate and multivariate analyses were performed to analyze the clinicopathological factors that might affect postoperative recurrence and metastasis and survival outcome.Kaplan-Meier survival curve and log-rank test were used to analyze disease free survival(DFS)and overall survival(OS).Chi-square test was performed to detect the difference in recurrence sites of different colpotomy paths.Results: A total of 1225 patients were embraced in the current research with a median follow-up of 60 months.Among all patients,493 patients met Peters criteria,Sedlis criteria and adenocarcinoma four-factor model,330 patients(66.9%)received appropriate postoperative adjuvant therapy,163 patients(33.1%)did not receive appropriate postoperative adjuvant therapy.Recurrence and metastasis occurred in 193 patients,and 152 patients died of the disease.The 5-year DFS were 99.0% for stage IA1,100% for stage IA2,89.6% for stage IB1,78.8% for stage IB2,77.2% for stage IIA1 and 72.2% for stage IIA2.The 5-year OS was99.0% for stage IA1,100% for stage IA2,93.5% for stage IB1,82.1% for stage IB2,82.3%for stage IIA1,and 75.2% for stage IIA2.COX proportional hazards model multivariate analysis showed that clinical stage,tumor diameter,lymph node metastasis(LNM),uterine corpus invasion(UCI)and postoperative adjuvant therapy had statistically significant effects on recurrence and metastasis and survival outcome of stage IA1-IIA2 cervical cancer after LRH.In the subgroup analysis,different influence factors of recurrence,metastasis and overall survival were found separately in stage IB1 and IB2-IIA2 cervical cancer.For patients with stage IB1,the risk factors of DFS were LNM,parametrial invasion(PI)and UCI,and the risk factors of OS are PI,UCI and perineural invasion.For patients with IB2-IIA2 stage,the risk factors for DFS were LNM and UCI,and the risk factors for OS were LNM,UCI,vaginal margin,cervical canal invasion and tumor diameter ≥4cm.UCI had a significant impact on the recurrence,metastasis and overall survival in IB1 and IB2-IIA2 cervical cancer both.A total of 940 patients with stage IB1-IIA2 were included in the analysis of different colpotomy paths,459 patients were performed LRH through vaginal colpotomy(VC group),and 481 patients were performed LRH through intracorporeal colpotomy(IC group).A total of 125 patients had recurrence and metastasis,and 57(12.4%)had recurrence and metastasis in VC group,including 3(0.7%)of intraperitoneal recurrence,25(5.4%)of pelvic recurrence,10(2.2%)of vaginal stump recurrence,and 19(4.1%)of lymph node and distant metastasis.There were 68(14.1%)of recurrence and metastasis in IC group,including 11(2.3%)of intraperitoneal recurrence,28(5.8%)of pelvic recurrence,10(2.1%)of vaginal stump recurrence,and 19(3.9%)of lymph node and distant metastasis.The total recurrence rates of different paths were insignificantly different(12.4% vs 14.1%,P=0.438),nor as in pelvic recurrence rate(P=0.803),vaginal stump recurrence rate(P=0.916),lymph node and distant metastasis rate(P=0.883).However,intraperitoneal recurrence rate was found of great significance(0.7% vs 2.3%,P=0.039).Conclusion:1.Clinical stage,tumor diameter,lymph node metastasis and uterine corpus invasion were risk factors affecting the recurrence,metastasis and survival outcomes of stage IA1-IIA2 cervical cancer after LRH.Conversely,postoperative adjuvant chemoradiotherapy was a protective factor.2.The prognosis of cervical cancer is different in different clinical stages,and the risk factors of cervical cancer are also different in different clinical stages.Uterine corpus invasion significantly affects recurrence,metastasis and survival outcomes of stage IB1 and IB2-IIA2 cervical cancer.3.For cervical cancer patients who met the Peters criteria/Sedlis criteria/adenocarcinoma four-factor model after surgery,appropriate adjuvant therapy significantly affected DFS and OS.4.Different colpotomy paths did not affect the total DFS and OS,but the intraperitoneal recurrence rate of VC group was significantly lower than that of IC group.Part2: Analysis of survival outcomes and surgical pathological characteristics of patients with stage IIB cervical cancer who underwent laparoscopic radical hysterectomy after neoadjuvant chemotherapyObjective: Radical hysterectomy after neoadjuvant chemotherapy(NACT)is one of the controversial points in the treatment of stage IIB cervical cancer.The aim of this study is to analyze the survival outcomes and risk factors of recurrence and metastasis in patients with stage IIB treated with neoadjuvant chemotherapy followed by radical hysterectomy,hoping to provide clinical data for the treatment strategy of these patients.Methods: The medical records and follow-up data of patients with stage IIB cervical cancer who underwent NACT followed by laparoscopic radical hysterectomy in the First Affiliated Hospital of Army Medical University from 2015 to 2018 were collected.KaplanMeier survival curve and Log-rank test were used to retrospectively analyze the survival outcome of patients who underwent surgery after NACT.COX regression analysis was used to analyze the surgical pathological characteristics,and the independent influencing factors were screened out for stratified analysis to compare the tumor outcomes of different subgroups.Results: A total of 178 patients were embraced in the current research with a median follow-up of 51 months.Among them,53 patients had recurrence and metastasis,and 41 patients died of disease.The 3-year disease free survival(DFS)and overall survival(OS)of laparoscopic radical hysterectomy after NACT for stage IIB cervical cancer were 75.4% and82.6%,respectively.COX multivariate analysis showed that lymph node metastasis(HR 2.038,95% CI 1.155-3.597)and deep myometrial invasion(HR 4.724,95% CI 2.106-10.595)were independent risk factors for DFS.Lymph node metastasis(HR 2.774,95% CI 1.475-5.215),deep myometrial invasion(HR 4.240,95% CI 1.698-10.978)and tumor diameter ≥4cm after NACT(HR 2.123,95% CI 1.144-3.942)were independent risk factors for OS.There were significant differences in DFS and OS between patients with or without deep myometrial invasion.The 3-year DFS were 64.1% and 92.8%(P< 0.001),and the 3-year OS were 73.2% and 95.7%,respectively(P< 0.001).There was no significant difference in DFS between patients with tumor diameter < 4cm and those with tumor diameter ≥4cm after NACT,while the 3-year OS were 85.1% and 74.4%,respectively(P=0.028).The DFS and OS of patients with tumor diameter reduction > 50% after NACT were significantly better than those of patients with tumor diameter reduction ≤50%.The 3-year DFS were 92.9% and 71.0%,respectively(P< 0.001),and the 3-year OS were 93.0% and 82.4%,respectively(P=0.017).Conclusion: 1.In addition to lymph node metastasis,myometrial invasion ≥2/3 is a risk factor for recurrence,metastasis and death,and tumor diameter ≥4 after NACT is a risk factor for postoperative death.For stage IIB patients with deep myometrial invasion,adjuvant therapy should be strengthened,while patients with insignificant efficacy after NACT are not suitable candidates for surgery.2.Radical surgery after NACT can be an alternative treatment for stage IIB cervical cancer.NACT sensitive patients can obtain better OS after surgery,especially for patients with tumor diameter reduction > 50%.Based on the efficacy of NACT,it may provide a reference for the screening of treatment strategies for stage IIB cervical cancer. |
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