既往宫颈锥切对早期宫颈癌腹腔镜与开腹根治性子宫切除术肿瘤学结局的影响：倾向评分加权回顾性观察研究
单中心回顾性研究纳入241例FIGO 2009 IA2、IB1、IIA1期宫颈癌患者，均先接受诊断性锥切再行根治性子宫切除术，比较腹腔镜（LRH，n=42）与开腹（ORH，n=199）的肿瘤学结局。中位随访超过6年，LRH组无死亡或复发，两组5年OS（100% vs 99.5%，p=.646）和PFS（100% vs 98.0%，p=.385）相当，PS-IPTW调整后无统计学显著差异。结论提示既往锥切患者中LRH肿瘤学结局与ORH相当。
要点
- 既往锥切患者中LRH组零死亡零复发，5年OS和PFS与ORH相当。
- PS-IPTW调整后两组生存结局仍无统计学显著差异。
- 既往宫颈锥切可能降低肿瘤播散风险，或为微创手术适宜亚组。
核心结论
- 在既往接受宫颈锥切的患者中，LRH的肿瘤学结局与ORH相当，与一般人群中的研究结果相反。
- 既往宫颈锥切可能降低肿瘤播散风险，提示该亚组可能适合微创手术。
研究设计与样本
- 单中心回顾性观察研究，采用倾向评分逆概率治疗加权（PS-IPTW）平衡协变量。
- LRH组42例，ORH组199例。
主要发现
- 中位随访超过6年，LRH组零死亡、零复发。
- LRH与ORH的5年OS分别为100%与99.5%（p=.646），5年PFS分别为100%与98.0%（p=.385）。
- PS-IPTW调整后确认生存结局无统计学显著差异。
临床怎么用
- 对于有宫颈锥切史的早期宫颈癌患者，LRH可作为与ORH肿瘤学结局相当的术式选择参考。
- 术前锥切史或有助于识别适合微创根治性子宫切除术的亚组。
局限性
- 单中心回顾性观察研究，LRH组样本量较小（n=42）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
STUDY OBJECTIVE: To compare long-term oncological outcomes of laparoscopic (LRH) versus open radical hysterectomy (ORH) in patients with early-stage cervical cancer who underwent prior cervical conization. DESIGN: A single-center retrospective observational study using propensity score-based inverse probability of treatment weighting (PS-IPTW) to balance covariates. SETTING: Shengjing Hospital of China Medical University, a tertiary academic medical center. PARTICIPANTS: A total of 241 patients with FIGO 2009 stage IA2, IB1, and IIA1 cervical cancer from January 1, 2014, to December 31, 2018, were included. All patients underwent diagnostic conization followed by radical hysterectomy and were restaged according to the FIGO 2018 classification. INTERVENTIONS: Patients underwent either laparoscopic radical hysterectomy (LRH, n = 42) or open radical hysterectomy (ORH, n = 199). MEASUREMENTS AND MAIN RESULTS: Primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS). Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Median follow-up exceeded 6 years. Remarkably, the LRH group experienced zero deaths or recurrences. The 5-year OS (100% vs 99.5%, p = .646) and PFS (100% vs 98.0%, p = .385) were comparable between LRH and ORH. Post-IPTW adjustment confirmed no statistically significant differences in survival outcomes. CONCLUSIONS: Contrary to findings in the general population, LRH yields excellent oncological outcomes comparable to ORH in patients with prior conization. Prior cervical conization may reduce the risk of tumor dissemination, suggesting a potentially suitable subgroup for minimally invasive surgery.
引用
- Shi G, Xiao Y, Han L, et al. Impact of Prior Conization on Oncological Outcomes of Laparoscopic versus Open Radical Hysterectomy in Early-Stage Cervical Cancer: A Propensity Score-Weighted Retrospective Observational Study. J Minim Invasive Gynecol. 2026. PMID: 42009127. doi:10.1016/j.jmig.2026.04.010
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。