OBJECTIVE To assess the effect on overall survival of simple hysterectomy with lymph node staging compared with radical hysterectomy with lymph node staging for patients with early-stage cervical cancer. METHODS We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with early cervical carcinoma of 2 cm or smaller (stage IA1 with lymphovascular space invasion through IIA1, International Federation of Gynecology and Obstetrics staging) from 2010 to 2019. After 1:1 propensity score matching, we compared patients who underwent simple hysterectomy with lymph node staging and those with radical hysterectomy with lymph node staging. The variables used for matching were age, tumor size, race and ethnicity, lymphovascular space invasion, year of diagnosis, Charlson-Deyo comorbidity score, histology, and surgical approach. The primary outcome was overall survival at the end of follow-up. Secondary outcomes included 30-day readmission rate and 30- and 90-day mortality rates. RESULTS In total, 4,167 patients met the inclusion criteria, of whom 2,637 patients (63.3%) underwent radical hysterectomy and lymph node staging and 1,530 patients (36.7%) underwent simple hysterectomy and lymph node staging. After propensity score matching, 1,529 patients in each group were included. There was no statistically significant difference in overall survival between patients who underwent simple hysterectomy and those who underwent radical hysterectomy (hazard ratio 1.25, 95% CI, 0.91-1.73, P=.17). Subgroup analysis by histology, lymphovascular space invasion, tumor size, and surgical approach did not reveal statistically significant differences in overall survival according to hysterectomy type. The hysterectomy groups also did not significantly differ in 30-day readmission rate (4.6% vs 4.2%, P=.73), 30-day mortality rate (0.1% vs 0%, P=.14), or 90-day mortality rate (0.1% vs 0.1%, P=.93). CONCLUSION Patients with low-risk cervical cancer could undergo less radical surgery without a negative effect on their oncologic outcomes.

中文翻译：

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早期宫颈癌患者简单子宫切除术后生存率。


目的 评估早期宫颈癌患者简单子宫切除术联合淋巴结分期与根治性子宫切除术联合淋巴结分期对总生存期的影响。方法 我们对 2010 年至 2019 年美国国家癌症数据库中诊断为 2 cm 或更小的早期宫颈癌 （IA1 期，通过 IIA1 浸润淋巴血管间隙，国际妇产科联合会分期） 的患者进行了回顾性队列研究。在 1：1 倾向评分匹配后，我们比较了接受简单子宫切除术联合淋巴结分期的患者和根治性子宫切除术联合淋巴结分期的患者。用于匹配的变量是年龄、肿瘤大小、种族和民族、淋巴血管间隙浸润、诊断年份、Charlson-Deyo 合并症评分、组织学和手术入路。主要结局是随访结束时的总生存期。次要结局包括 30 天再入院率以及 30 天和 90 天死亡率。结果 共有 4,167 例患者符合纳入标准，其中 2,637 例患者 （63.3%） 接受了根治性子宫切除术和淋巴结分期，1,530 例患者 （36.7%） 接受了简单子宫切除术和淋巴结分期。倾向评分匹配后，每组纳入 1,529 例患者。接受简单子宫切除术的患者和接受根治性子宫切除术的患者总生存期无统计学意义差异 （风险比 1.25,95% CI，0.91-1.73，P =.17）。根据子宫切除术类型，按组织学、淋巴血管间隙浸润、肿瘤大小和手术入路进行的亚组分析未显示总生存期的统计学显着差异。 子宫切除术组在 30 天再入院率 （4.6% vs 4.2%，P=.73） 、30 天死亡率 （0.1% vs 0%，P=.14） 或 90 天死亡率 （0.1% vs 0.1%，P=.93） 方面也没有显著差异。结论 低风险宫颈癌患者可以接受不太根治的手术，而不会对其肿瘤学结果产生负面影响。