Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer

doi:10.1056/NEJMoa1806395

科研成果详情

题名	Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer
作者	Ramirez, Pedro T.1; Frumovitz, Michael 1; Pareja, Rene 2,3; Lopez, Aldo 4; Vieira, Marcelo 5; Ribeiro, Reitan 6; Buda, Alessandro 8; Yan, Xiaojian9; Yao Shuzhong 10; Chetty, Naven 12; Isla, David 17; Tamura, Mariano 7; Zhu, Tao 11; Robledo, Kristy P.13; Gebski, Val 13; Asher, Rebecca 13; Behan, Vanessa 14,15; Nicklin, James L.16; Coleman, Robert L.1; Obermair, Andreas 14,15
发表期刊	NEW ENGLAND JOURNAL OF MEDICINE 影响因子和分区
语种	英语
原始文献类型	Article
其他关键词	RANDOMIZED CLINICAL-TRIAL ; LAPAROSCOPIC-ASSISTED RESECTION ; GYNECOLOGIC-ONCOLOGY ; PATHOLOGICAL OUTCOMES ; SURVIVAL OUTCOMES ; RECTAL-CANCER ; SURGERY ; METAANALYSIS ; LAPAROTOMY ; EXPERIENCE
摘要	BACKGROUND There are limited data from retrospective studies regarding whether survival outcomes after laparoscopic or robot-assisted radical hysterectomy (minimally invasive surgery) are equivalent to those after open abdominal radical hysterectomy (open surgery) among women with early-stage cervical cancer. METHODS In this trial involving patients with stage IA1 (lymphovascular invasion), IA2, or IB1 cervical cancer and a histologic subtype of squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, we randomly assigned patients to undergo minimally invasive surgery or open surgery. The primary outcome was the rate of disease-free survival at 4.5 years, with noninferiority claimed if the lower boundary of the two-sided 95% confidence interval of the between-group difference (minimally invasive surgery minus open surgery) was greater than -7.2 percentage points (i.e., closer to zero). RESULTS A total of 319 patients were assigned to minimally invasive surgery and 312 to open surgery. Of the patients who were assigned to and underwent minimally invasive surgery, 84.4% underwent laparoscopy and 15.6% robot-assisted surgery. Overall, the mean age of the patients was 46.0 years. Most patients (91.9%) had stage I131 disease. The two groups were similar with respect to histologic subtypes, the rate of lymphovascular invasion, rates of parametrial and lymph-node involvement, tumor size, tumor grade, and the rate of use of adjuvant therapy. The rate of disease-free survival at 4.5 years was 86.0% with minimally invasive surgery and 96.5% with open surgery, a difference of-10.6 percentage points (95% confidence interval (CI), -16.4 to -4.7). Minimally invasive surgery was associated with a lower rate of diseasefree survival than open surgery (3-year rate, 91.2% vs. 97.1%; hazard ratio for disease recurrence or death from cervical cancer, 3.74; 95% CI, 1.63 to 8.58), a difference that remained after adjustment for age, body-mass index, stage of disease, lymphovascular invasion, and lymph-node involvement; minimally invasive surgery was also associated with a lower rate of overall survival (3-year rate, 93.8% vs. 99.0%; hazard ratio for death from any cause, 6.00; 95% CI, 1.77 to 20.30). CONCLUSIONS In this trial, minimally invasive radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open abdominal radical hysterectomy among women with early-stage cervical cancer.
资助项目	Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center; MedtronicMedtronic
出版者	MASSACHUSETTS MEDICAL SOC
出版地	WALTHAM
ISSN	0028-4793
EISSN	1533-4406
卷号	379 期号:20 页码:1895-1904
DOI	10.1056/NEJMoa1806395
WOS类目	Medicine, General & Internal
WOS研究方向	General & Internal Medicine
WOS记录号	WOS:000450049800004
收录类别	SCIE ; PUBMED ; SCOPUS
发表日期	2018-11-15
URL	查看原文
Pubmed记录号	30380365
Scopus记录号	2-s2.0-85056625527
ESI热点论文	2020-01 ; 2020-03 ; 2020-05 ; 2020-09 ; 2020-11 ; 2021-01
ESI高被引论文	2020-03 ; 2020-05 ; 2020-09 ; 2020-11 ; 2021-01 ; 2021-03 ; 2021-05 ; 2021-07 ; 2021-11 ; 2022-01 ; 2022-03 ; 2022-07 ; 2022-09 ; 2022-11 ; 2023-01 ; 2023-03 ; 2023-05 ; 2023-07 ; 2023-09 ; 2023-11 ; 2024-01 ; 2024-03 ; 2024-05
自科自定义期刊分类	T1类
引用统计	被引频次：885[WOS] [WOS记录] [WOS相关记录]
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/20752
专题	第一临床医学院（信息与工程学院）、附属第一医院_妇产科学_妇科附属第一医院
通讯作者	Ramirez, Pedro T.
作者单位	1.Univ Texas MD Anderson Canc Ctr, Dept Gynecol Oncol & Reprod Med, Unit 1362,1515 Holcombe Blvd, Houston, TX 77030 USA; 2.Inst Nacl Cancerol, Dept Gynecol Oncol, Bogota, Colombia; 3.Clin Oncol Astorga, Medellin, Colombia; 4.Inst Nacl Enfermedades Neoplas, Dept Gynecol Surg, Lima, Peru; 5.Barretos Canc Hosp, Dept Gynecol Oncol, Barretos, Brazil; 6.Erasto Gaertner Hosp, Dept Surg Oncol, Curitiba, Parana, Brazil; 7.Albert Einstein Hosp, Dept Gynecol Oncol, Sao Paulo, Brazil; 8.San Gerardo Hosp, Dept Obstet & Gynecol, Unit Gynecol Oncol Surg, Monza, Italy; 9.Wenzhou Med Univ, Dept Gynecol, Affiliated Hosp 1, Wenzhou, Peoples R China; 10.Sun Yat Sen Univ, Dept Obstet & Gynecol, Affiliated Hosp 1, Guangzhou, Guangdong, Peoples R China; 11.Zhejiang Canc Hosp, Dept Gynecol Oncol, Hangzhou, Zhejiang, Peoples R China; 12.Mater Hlth Serv Brisbane, Dept Gynecol Oncol, South Brisbane, Australia; 13.Univ Sydney, Natl Hlth & Med Res Council Clin Trials Ctr, Sydney, NSW, Australia; 14.Univ Queensland, Queensland Ctr Gynaecol Canc Res, Brisbane, Qld, Australia; 15.Univ Queensland, Fac Med, Brisbane, Qld, Australia; 16.Royal Brisbane & Womens Hosp, Dept Gynaecol Oncol, Herston, Qld, Australia; 17.Inst Nacl Cancerol, Dept Gynecol Oncol, Mexico City, DF, Mexico
推荐引用方式 GB/T 7714	Ramirez, Pedro T.,Frumovitz, Michael,Pareja, Rene,et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer[J]. NEW ENGLAND JOURNAL OF MEDICINE,2018,379(20):1895-1904.
APA	Ramirez, Pedro T.., Frumovitz, Michael., Pareja, Rene., Lopez, Aldo., Vieira, Marcelo., ... & Obermair, Andreas. (2018). Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. NEW ENGLAND JOURNAL OF MEDICINE, 379(20), 1895-1904.
MLA	Ramirez, Pedro T.,et al."Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer".NEW ENGLAND JOURNAL OF MEDICINE 379.20(2018):1895-1904.