早期宫颈癌根治性子宫颈切除术的肿瘤结局与微创手术影响
韩国妇科肿瘤组多中心回顾性分析283例2004-2022年接受根治性子宫颈切除术的早期宫颈癌患者，中位随访59.6个月，DFS 88.3%、OS 96.1%，肿瘤<2 cm者DFS 90.5%、OS 98.1%，微创手术未显著影响DFS或OS，59例生育数据中62.7%受孕、56.8%活产。
要点
- 肿瘤<2 cm者DFS 90.5%、OS 98.1%，预后良好
- 术前LEEP为保护因素（HR 0.341），LVSI和阴道受累为独立不良因素
- 微创手术未显著影响DFS（p=0.118）或OS（p=0.840）
核心结论
- 根治性子宫颈切除术在早期宫颈癌中显示良好肿瘤与生育结局，肿瘤<2 cm者尤佳。
- 微创手术未损害生存，支持其作为合适筛选患者的保留生育选择。
研究设计与样本
- 韩国妇科肿瘤组多中心回顾性队列研究（KGOG 1048），纳入283例2004-2022年接受根治性子宫颈切除术的早期宫颈癌患者。
- 排除接受新辅助化疗或转为根治性子宫切除术者，采用Cox回归分析生存结局。
主要发现
- 中位随访59.6个月（范围4.3-198.6），中位肿瘤大小16.0 mm（范围2.0-70.0）。
- DFS 88.3%、OS 96.1%，复发率11.7%、死亡率3.9%；肿瘤<2 cm者DFS 90.5%、OS 98.1%。
- 术前LEEP为保护因素（HR 0.341，95%CI 0.161-0.718；p=0.005）。
- LVSI（HR 2.191，95%CI 1.033-4.647；p=0.041）和阴道受累（HR 3.108，95%CI 1.130-8.550；p=0.028）为独立不良预后因素。
- 微创手术与DFS（p=0.118）或OS（p=0.840）无显著不良关联；59例生育数据中62.7%受孕（n=37）、56.8%活产（n=21），已知分娩中早产52.4%。
关键数值与推荐
- 肿瘤<2 cm者DFS 90.5%、OS 98.1%。
- 术前LEEP：HR 0.341（95%CI 0.161-0.718；p=0.005）。
- LVSI：HR 2.191（95%CI 1.033-4.647；p=0.041）。
- 阴道受累：HR 3.108（95%CI 1.130-8.550；p=0.028）。
- 微创手术：DFS p=0.118，OS p=0.840。
临床怎么用
- 对肿瘤<2 cm的早期宫颈癌患者，根治性子宫颈切除术可作为保留生育的可行选择。
- 术前LEEP、无LVSI及无阴道受累者预后更佳，可辅助筛选合适患者。
- 微创手术未显示生存劣势，但需结合个体情况谨慎选择。
局限性
- 回顾性多中心设计，存在选择偏倚可能。
- 生育结局仅59例可获取，样本量有限。
- 微创手术与开腹手术未随机分组，混杂因素可能影响比较。
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
OBJECTIVE: This study aimed to investigate long-term oncologic outcomes, assess the impact of minimally invasive surgery (MIS) in patients with early-stage cervical cancer who underwent radical trachelectomy, and evaluate postoperative fertility outcomes. METHODS: This study analyzed 283 patients with early-stage cervical cancer who underwent radical trachelectomy between 2004 and 2022. Patients who received neoadjuvant chemotherapy or were converted to radical hysterectomy were excluded. Clinicopathological and surgical data were collected; survival outcomes were evaluated using Cox regression analysis. RESULTS: The median follow-up was 59.6 months (range, 4.3-198.6). The median tumor size was 16.0 mm (range, 2.0-70.0). Disease-free survival (DFS) and overall survival (OS) rates were 88.3% and 96.1%, respectively; the recurrence and mortality rates were 11.7% and 3.9%, respectively. Among tumors <2 cm in size, the DFS and OS rates were 90.5% and 98.1%, respectively. Preoperative loop electrosurgical excision procedure (LEEP) was a protective factor (HR 0.341, 95% CI 0.161-0.718; p = 0.005), whereas lymphovascular space invasion (LVSI) (HR 2.191, 95% CI 1.033-4.647; p = 0.041) and vaginal extension (HR 3.108, 95% CI 1.130-8.550; p = 0.028) were independent adverse prognostic factors. MIS was not adversely associated with DFS (p = 0.118) or OS (p = 0.840). Fertility outcomes were available for 59 patients; 62.7% of them conceived (n = 37) and 56.8% of them delivered live births (n = 21). Preterm births occurred in 52.4% of known deliveries. CONCLUSION: Radical trachelectomy demonstrated favorable oncologic and fertility outcomes in early-stage cervical cancer, especially in tumors <2 cm in size. MIS did not compromise survival, supporting radical trachelectomy as a feasible fertility-preserving option for appropriately selected patients.
引用
- Kim JH, Hwang WY, Choi CH, et al. Oncologic outcomes and the impact of minimally invasive surgery in early-stage cervical cancer patients undergoing radical trachelectomy: A retrospective multicenter cohort study from the Korean Gynecologic Oncology Group Study (KGOG 1048). Gynecol Oncol. 2026. PMID: 42013607. doi:10.1016/j.ygyno.2026.04.003
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。