PO.PS01.10 · 人群科学

早期宫颈癌的手术方式与五年生存率：一项国家癌症数据库分析

Surgical approach and five year survival in early stage cervical cancer: A national cancer database analysis

编号 871 展板 17 时间 4/19 02:00–05:00 区域 Section 34 主讲 Sejong Bae, PhD

分会场 Survivorship Research

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作者与单位 Authors & Affiliations

Vishruti Pandya¹, Marguerite R. Irvin², Sharad Ghamande³, Charles A. Leath¹, Chenguang Wang⁴, Steve Coughlin⁵, Warner K. Huh¹, Sejong Bae⁵

¹Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL,²Epidemiology, University of Alabama at Birmingham, Birmingham, AL,³Obstetrics and Gynecology, Augusta University, Augusta, GA,⁴Statistical Innovation Biostatistics and Data Management, Regeneron, Basking Ridge, NJ,⁵Biostatistics, Data Science, and Epidemiology, Augusta University, Augusta, GA

摘要 Abstract

中文摘要

背景：早期宫颈癌的最佳手术方式仍存在争议，尤其是在宫颈癌腹腔镜手术（LACC）试验对微创手术（MIS）提出担忧之后。本研究评估手术方式（机器人/MIS对比开放手术）与五年生存率之间的关联，并考虑人口统计学、机构和临床因素。方法：我们分析了国家癌症数据库（NCDB）中2004-2022年间确诊为AJCC I-IIA期宫颈癌并接受手术的患者数据。患者被分类为病例（五年内死亡）或对照（五年时存活）。多变量logistic回归评估了手术方式与五年死亡率之间的关联，并对年龄、种族、保险、机构类型、地理区域、就诊距离、肿瘤分级、合并症、辅助治疗、住院时长及30天再入院进行校正。结果：在18,849名患者中，2,263名（12.0%）在五年内死亡。与开放手术相比，机器人/MIS与更低的五年死亡率相关（校正OR：0.86；95% CI：0.76-0.99）。更高的死亡率独立地与接受辅助治疗（aOR：1.79）、年龄较大（每岁aOR：1.05）、黑人种族（aOR：1.40）、公共保险（aOR：1.41）、在综合社区癌症中心接受治疗（aOR：1.38）、就诊距离>50英里（aOR：1.35）、更高的肿瘤分级（aOR：2.66）及更重的合并症负担（aOR：2.30）相关。再入院率在不同手术方式间无显著差异。结论：在早期宫颈癌中，机器人/MIS与开放手术相比显著相关于改善的五年生存率。然而，人口统计学、机构和临床因素，包括种族、保险、机构类型和合并症，也是死亡率的强预测因素，凸显了持续存在的差异。这些发现强调了解决医疗不平等和优化诊疗服务提供的必要性。未来的研究应进一步探讨患者和系统性因素如何调节生存结局。

查看英文原文 English abstract

Background: The optimal surgical approach for early-stage cervical cancer remains debated, especially after the Laparoscopic Approach to Cervical Cancer (LACC) trial raised concerns about minimally invasive surgery (MIS). This study evaluates the association between surgical approach (robotic/MIS vs. open surgery) and five-year survival, accounting for demographic, facility, and clinical factors. Methods: We analyzed data from the National Cancer Database (NCDB) for patients diagnosed with AJCC stage I-IIA cervical cancer from 2004-2022 who underwent surgery. Patients were classified as cases (died within five years) or controls (alive at five years). Multivariable logistic regression assessed the association between surgical approach and five-year mortality, adjusting for age, race, insurance, facility type, geographic region, distance traveled, tumor grade, comorbidity, adjuvant therapy, length of stay, and 30-day readmission. Results: Among 18,849 patients, 2,263 (12.0%) died within five years. Robotic/MIS was associated with lower five-year mortality compared to open surgery (adjusted OR: 0.86; 95% CI: 0.76-0.99). Higher mortality was independently associated with receipt of adjuvant therapy (aOR: 1.79), older age (aOR per year: 1.05), Black race (aOR: 1.40), public insurance (aOR: 1.41), treatment at comprehensive community cancer centers (aOR: 1.38), travel >50 miles (aOR: 1.35), higher tumor grade (aOR: 2.66), and greater comorbidity burden (aOR: 2.30). Readmission rates did not differ significantly by surgical approach. Conclusions: Robotic/MIS was significantly associated with improved five-year survival compared to open surgery in early-stage cervical cancer. However, demographic, facility, and clinical factors, including race, insurance, facility type, and comorbidities, were also strong predictors of mortality, highlighting persistent disparities. These findings underscore the need to address healthcare inequities and optimize care delivery. Future research should further explore how patient and systemic factors modify survival outcomes.

利益披露 Disclosure

V. Pandya, None.. M. R. Irvin, None.. S. Ghamande, None. C. A. Leath, Seattle Genetics cervical cancer Consulting fees. Merck cervical cancer Consulting. C. Wang, None.. S. Coughlin, None. W. K. Huh, NIHNCI ), P50 CA098252. S. Bae, None.

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